



Class. 



Book-- 



COPYRIGHT DEPOSIT 



HABITS 
THAT HANDICAP 



HABITS 
THAT HANDICAP 

The Menace of Opium, Alcohol, and Tobacco, 
and the Remedy 



BY 



CHARLES B. TOWNS 




NEW YORK 
THE CENTURY CO. 
1915 



« c £ 



Copyright, 1915, by 
The Century Co. 

Published, August, 1915 



AUG 20 1915 



CI.A41113 3 



PEEFACE 

It is interesting to note that a year or more 
ago a few deaths from bichlorid of mercury 
poisoning caused within a period of six months 
a general movement toward protective legisla- 
tion. This movement was successful, and after 
the lapse of only a short time the public was 
thoroughly protected against this dangerous 
poison. It will be observed that the financial 
returns from the total sale of bichlorid of mer- 
cury tablets could be but small. Had the 
financial interests involved been of a magnitude 
comparable with those interested in the manu- 
facture and promotion of habit-forming drugs, I 
have often wondered if the result would not have 
been less effective and as prompt. Bichlorid of 
mercury never threatened any large proportion 
of the public, and those falling victims to it 
merely die. Opium and its derivatives threaten 
the entire public, especially those who are sick 
and in pain, and with a fate far more terrible 
than death — a thraldom of misery, inefficiency, 
and disgrace. 



vi PREFACE 

Lest somewhere there be found within the 
pages of this book remarks that may lead the 
reader to suppose that I unduly criticize the 
doctor, and therefore that I am the doctor's 
enemy, I feel that it behooves me to add that in 
the whole community he has not one admirer 
more whole-souled. 



PEEFACE 

Some years ago, Mr. Charles B. Towns came 
to. me with a letter from Dr. Alexander Lambert 
and claimed that he had a way of stopping the 
morphia habit. The claim seemed to me an en- 
tirely impossible statement, and I told Mr. 
Towns so; but at Dr. Lambert's suggestion, I 
promised to look into the matter. Accordingly, 
I visited Mr. Towns's hospital, and watched the 
course of treatment there at different times in 
the day and night. I became convinced that the 
withdrawal of morphine was accomplished un- 
der this treatment with vastly less suffering 
than that entailed by any other treatment or 
method I had ever seen. Subsequently, I sent 
Mr. Towns several patients, who easily and 
quickly were rid of their morphia addiction, and 
have now remained well for a number of years. 

At that time I had the impression that the 
treatment was largely due to the force of Mr. 
Towns's very vigorous and helpful personality, 
but when subsequently a similar institution was 
established near Boston, I became convinced by 

vii 



viii PEEFACE 

observation of cases treated in that hospital that 
Mr. Towns's personality was not an essential 
element in that treatment. His skill, however, 
in the actual management of cases, from the 
medical point of view, was very hard to dupli- 
cate, and Mr. Towns generously came from New 
York, when called upon, and showed us what was 
wrong in the management of cases which were 
not doing well. I do not hesitate to say that he 
knows more about the alleviation and cure of 
drug addictions than any doctor that I have ever 
seen. 

All the statements made in this book except 
those relating to tobacco I can verify from sim- 
ilar experiences of my own, since I have known 
and used Mr. Towns 's method of treatment. 

I do not pretend to say how his treatment 
accomplishes the results which I have seen it 
accomplish, but I have yet to learn of any one 
who has given it a thorough trial who has 
obtained results differing in any considerable 
way from those to which Mr. Towns refers. 

The wider applications and generalizations of 
the book seem to me very instructive. The 
shortcomings of the medical profession, of the 
druggists, and those who have to do with the 
management of alcoholics in courts of law seem 



PKEFACE ix 

to me well substantiated by the facts. Mr. 
Towns's plans for legislative control of drug 
habits also seem to me wise and far-reaching. 
He is, I believe, one of the most public-spirited 
as well as one of the most honest and forceful 
men that I have ever known. 

I am glad to have this opportunity of express- 
ing my faith and confidence in him and my sense 
of the value of the book he has written. 

Richard C. Cabot. 



INTEODUCTION 

There is only one way by means of which, 
humanity can be relieved of the curse of drug 
using, and that is to adopt methods putting the 
entire responsibility upon the doctor. Until the 
present legislation was passed in New York 
State, no one had ever considered the doctor's 
responsibility; this most valuable medical asset 
and most terrible potential curse had been virtu- 
ally without safeguard of any effective kind. 
Discussion of the drug problem in the press 
dealt wholly with those phases which make 
themselves manifest in the underworld or among 
the Chinese. I am reasonably certain that until 
very recently the world had heard nothing of 
the blameless men and women who had become 
drug-users as the result of illness. This seems 
strange, since there are in the United States 
more victims of the drug habit than there are of 
tuberculosis. It is estimated that fifteen per 
cent, of the practising physicians in the country 
are addicted to the habit, and although I think 
this is an exaggeration, it is nevertheless true 

xi 



xii INTEODUCTION 

that habit-forming drugs demand a heavy toll 
from the medical profession, wrecking able 
practitioners in health and reputation, and of 
course seriously endangering the public. 

I have elsewhere explained the fact that the 
medical man himself is ignorant of the length 
to which he can safely go in the administration 
of drugs to his patients. If he is ignorant of 
what quantity and manner of dosage constitutes 
a peril for the patient, is it not reasonable to 
suppose that similar ignorance exists in his 
mind with regard to his own relations with the 
drug habit I As a matter of fact, I know this to 
be the case; many physicians have come to me 
for help, and ninety-nine per cent, of them ex- 
plained to me that their use of drugs was the 
direct outgrowth of their ignorance. If the man 
who practises medicine is unaware of what will 
bring about the habit, what can be expected of 
the medically uneducated citizen who is threat- 
ened by those in whom he has most confidence — 
his doctors? 

The wide extent of the drug habit in this coun- 
try has not been apparent. The man suffering 
from a physical disease either shows it or makes 
it known ; the man suffering from the drug habit 
presents unfamiliar and unidentified symptoms, 



INTBODUCTION xiii 

and far from being willing to make his affliction 
known, through shame he tries to conceal it at 
all hazards. Until legislation forced the victims 
of drug habits by hundreds into Bellevue Hospi- 
tal in New York, this great institution rarely 
had one as a patient. The sufferer from tuber- 
culosis would seek this hospital, feeling that 
there he might find measurable relief ; the drug- 
user shunned it, for he was doubtful of receiving 
aid, and above all things he dreaded depriva- 
tion without relief. No man or woman will go 
to any institution for relief from the drug habit 
where the only treatment offered is that of en- 
forced deprivation, for he or she knows per- 
fectly well that deprivation means death. No 
human longing can compare in intensity with 
that of the drug-user for his drug. Unrelieved, 
he will let nothing stand between him and it; 
neither hunger, nakedness, starvation, arson, 
theft, nor murder will keep him from the sub- 
stance that he craves. Clearly humanity must 
be protected against such an evil. And the phy- 
sician must be saved from it, for saving him will 
fulfil in a large measure the demand for the pro- 
tection of the public. 

After the experience of the medical profes- 
sion of New York State with the workings of the 



• 



xiv INTBODUCTION 

Boylan Act, it is scarcely probable that strong 
opposition to similar legislation will be made in 
other States. Even if other States delay in the 
enactment of right legislation, the Boylan Act 
may be considered not only a protective measure 
for the profession and the people of New York 
State, but it may be safely accepted as an educa- 
tional pronouncement for the benefit of the med- 
ical profession everywhere. It establishes for 
the first time the danger-line. 



CONTENTS 



CHAPTER PAGE 

I_ THE PERIL OP THE DRUG HABIT 3 

II THE NEED OP ADEQUATE SPECIFIC TREATMENT 

FOR THE DRUG-TAKER 27 

III THE DRUG-TAKER AND THE PHYSICIAN .... 46 

IV PSYCHOLOGY AND DRUGS 61 

V ALCOHOLICS 76 

VI HELP FOR THE HARD DRINKER 87 

VII CLASSIFICATION OF ALCOHOLICS 113 

VIII THE INJURIOUSNESS OF TOBACCO 140 

IX TOBACCO AND THE FUTURE OF THE RACE . . .162 

X THE SANATORIUM 174 

XI PREVENTIVE MEASURES FOR THE DRUG EVIL . . 194 

XII CLASSIFICATION OF HABIT-FORMING DRUGS . .215 

XIII PSYCHOLOGY OF ADDICTION 227 

APPENDIX 265 



HABITS THAT HANDICAP 



HABITS THAT HANDICAP 

CHAPTER I 

THE PERIL OF THE DRUG HABIT 

IT is human nature to wish to ease pain and 
to stimulate ebbing vitality. There is no 
normal adult who, experiencing severe pain or 
sorrow or fatigue, and thoroughly appreciating 
the immediate action of an easily accessible 
opiate, is not likely in a moment of least resist- 
ance to take it. Every one who has become 
addicted to a drug has started out with small 
occasional doses, and no one has expected to fall 
a victim to the habit; indeed, many have been 
totally unaware that the medicine they were 
taking contained any drug whatever. Thus, the 
danger being one that threatens us all, it is 
every man's business to insist that the entire 
handling and sale of the drug be under as care- 
ful supervision as possible. It is not going too 
far to say that up to the present time most drug- 
takers have been unfairly treated by society. 

3 



4 HABITS THAT HANDICAP 

They have not been properly safeguarded from 
forming the habit or properly helped to over- 
come it. 

It has been criminally easy for any one to 
acquire the drug habit. Few physicians have 
recognized that it is not safe for most persons to 
know what will ease pain. When an opiate is 
necessary, it should be given only on prescrip- 
tion, and its presence should then be thoroughly 
disguised. A patient goes to a physician to be 
cured; consequently, when his pain disappears, 
he naturally believes that this is due to the treat- 
ment he has received. If the physician has used 
morphine in a disguised form, the patient natu- 
rally believes that the cure was effected by some 
unknown medicine ; but if, on the other hand, he 
has received morphine knowingly, he realizes at 
once that it is this drug which is responsible for 
easing his pain. If he has received it hypo- 
dermically, the idea is created in his mind that a 
hypodermic is a necessary part of the treatment. 
Thus it is clear that the physician who uses his 
syringe without extreme urgency is greatly to 
be censured, for the patient who has once seen 
his pain blunted by the use of a hypodermic 
eagerly resorts to this means when the pain re- 
turns. Conservative practitioners are keenly 



THE PEEIL OF THE DRUG HABIT 5 

aware of this responsibility, and some go so far 
as never to carry a hypodermic on their visits, 
though daily observation shows that the average 
doctor regards it as indispensable. The con- 
servative physician employs only a very small 
quantity of morphine in any form. One of the 
busiest and most successful doctors of my ac- 
quaintance has used as little as half a grain a 
year, and another told me he had never gone 
beyond two grains. 

Both of these men know very well that only a 
small percentage of drug-takers have begun the 
practice in consequence of a serious ailment, and 
that even this small percentage might have been 
decreased by proper medical treatment directed 
at the cause rather than at its symptom, pain. 
An opiate, of course, never removes the cause 
of any physical trouble, but merely blunts the 
pain due to it; and it does this by tying up the 
functions of the body. It is perhaps a conserv- 
ative estimate that only ten per cent, of the 
entire drug consumption in this country is ap- 
plied to the purpose of blunting incurable pain. 
Thus ninety per cent, of the opiates used are, 
strictly speaking, unnecessary. In the innumer- 
able cases that have come under my observation, 
seventy-five per cent, of the habitual users be- 



6 HABITS THAT HANDICAP 

came such without . reasonable excuse. Begin- 
ning with small occasional doses, they realized 
within a few weeks that they had lost self- 
control and could not discontinue the use of the 
drug. 

FORMING THE HABIT 

A very common source of this habit lies in 
the continued administration of an opiate in reg- 
ular medical treatment without the patient's 
knowledge or consent, or in the persistent use of 
a patent medicine, or of a headache or catarrh 
powder that contains such a drug. 

The man who takes an opiate consciously or 
unconsciously, and receives from it a soothing 
or stimulating or pleasant effect, naturally turns 
to it again in case of the same need. The time 
soon arrives when the pleasurable part of the 
effect — if it was ever present — ceases to be ob- 
tained ; and in order to get the soothing or stim- 
ulating effect, the dose must be constantly 
increased as tolerance increases. With those 
who take a drug to blunt a pain which can 
be removed in no other way, it is fulfilling its 
legitimate and supreme mission and admits of 
no substitute. Where it was ever physically 
necessary, and that necessity still continues, an 



THE PERIL OF THE DRUG HABIT 7 

opiate would seem inevitable. But the percent- 
age of such sufferers, as I have said, is small. 
The rest are impelled simply by craving — that 
intolerable craving which arises from depriva- 
tion of the drug. 

But whether a man has acquired the habit 
knowingly or unknowingly, its action is always 
the same. No matter how conscientiously he 
wishes to discharge his affairs, the drug at once 
begins to loosen his sense of moral obligation, 
until in the end it brings about absolute irre- 
sponsibility. Avoidance and neglect of custom- 
ary duties, evasion of new ones, extraordinary 
resourcefulness in the discovery of the line of 
least resistance, and finally amazing cunning 
and treachery — this is the inevitable history. 

The drug habit is no respecter of persons. I 
have had under my care exemplary mothers and 
wives who became indifferent to their families ; 
clergymen of known sincerity and fervor who 
became shoplifters and forgers; shrewd, suc- 
cessful business men who became paupers, be- 
cause the habit left them at the mercy of sharp- 
ers after mental deterioration had set in. But 
the immediate action of morphine by no means 
paralyzes the mental faculties. Though when 
once a man becomes addicted to the drug he is 



8 HABITS THAT HANDICAP 

incapacitated to deal with himself, yet while he 
is under its brief influence his mind is sharp- 
ened and alert. Under the sway of opium a 
man does venturesome or immoderate things 
that he would never think of doing otherwise, 
simply because he has lost the sense of responsi- 
bility. I have had patients who took as much as 
sixty grains of morphine in a single dose, an 
overdose for about one hundred and fifty people, 
and about fifty grains more than the takers 
could possibly assimilate or needed to produce 
the required result — an excellent illustration of 
how the habit destroys all judgment and all 
sense of proportion. 

Against this appalling habit, which can be ac- 
quired easily and naturally and the result of 
which is always complete demoralization, there 
is at present no effective safeguard except that 
provided by nature itself, and this is effective 
only in certain cases. It happens that in many 
people opium produces nausea, and this one 
thing alone has saved some from the habit ; for 
this type of user never experiences any of the 
temporarily soothing sensations commonly at- 
tributed to the drug. Yet this pitiful natural 
safeguard, while rarely operative, is more ef- 
ficacious than any other that up to the present 



THE PERIL OF THE DRUG HABIT 9 

has been provided by man in his heedlessness, 
indifference, and greed. 

DANGEKS OF THE HYPODERMIC SYRINGE 

I have seen over six thousand cases of drng 
habit in various countries of the world. Ninety- 
five per cent, of the patients who have come to 
me taking morphine or other alkaloids of opium 
have taken the drug hypodermically. With few 
exceptions, I have found that the first knowledge 
of it came through the administration of a hypo- 
dermic by a physician. It is the instrument 
used that has shown the sufferer what was 
easing his pain. I consider that among those 
who have acquired the habit through sickness 
or injury this has been the chief creator of the 
drug habit. This statement does not apply to 
those who have acquired the habit through the 
taking of drugs otherwise. My work has been 
carried out almost entirely in cooperation with 
the physician, and I have not come in contact 
with the under-world drug-takers. I consider 
that the syringe has been the chief creator of 
the drug habit in this country. In 1911 I made 
this statement before the Ways and Means Com- 
mittee of the United States Congress, then oc- 
cupied with the matter of regulating the sale of 



10 HABITS THAT HANDICAP 

habit-forming drugs, and I personally secured 
the act which was passed by the New York legis- 
lature in February, 1911, to restrict the sale of 
this instrument to buyers on a physician's pre- 
scription. Before that time all drug stores and 
most department stores sold hypodermic instru- 
ments to any one who had the money. A boy of 
fifteen could buy a syringe as easily as he could 
buy a jack-knife. If a physician refused to give 
an injection, the patient could get an instrument 
anywhere and use it on himself. This bill has 
passed only a single legislature, but I am ar- 
ranging to introduce a similar bill before all the 
others, and hope to have the State action con- 
firmed by a Federal bill. At present in Jersey 
City, or anywhere out of New York, any one 
may still buy the instrument. It is inconceiv- 
able that the syringe should have gone so long 
without being considered the chief factor in the 
promotion of a habit which now alarms the 
world, and that as yet only one state legislature 
should have seen fit to regulate its sale. Be- 
st ricting the sale of the syringe to physicians, 
or to buyers on a physician's prescription, is the 
first step toward placing the grave responsibil- 
ity for the drug habit on the shoulders of those 
to whom it belongs. 



THE PERIL OF THE DRUG HABIT 11 

HABIT-FORMING DRUGS IN PATENT MEDICINES 

The second step to be taken is to prevent by 
law the use of habit-forming drugs in patent and 
proprietary medicines which can be bought 
without a physician's prescription. Prior to 
the Pure Food and Drugs Act, created and pro- 
moted by Dr. H. W. Wiley, druggists and 
patent-medicine venders were able, without an- 
nouncing the fact, to sell vast quantities of habit- 
forming drugs in compounds prepared for 
physical ailments. When that act came into 
effect, these men were obliged to specify on the 
label the quantities of such drugs used in these 
compounds, and thus the purchaser was at least 
enabled to know that he was handling a danger- 
ous tool. Except in a few States, however, the 
sale of these compounds was in no way re- 
stricted, and hence the act cannot be said to have 
done much toward checking the formation of the 
drug habit. Indeed, it has probably worked the 
other way, for there is perhaps not an adult liv- 
ing who does not know that certain drugs will 
alleviate pain, and people who have pains and 
aches are likely to resort to an accessible and 
generally accredited means of alleviation. Yet 
the difficulties in the way of passing the Pure 



12 HABITS THAT HANDICAP 

Food and Drugs Act are a matter of scandalous 
history. What, then, would be the difficulties 
in passing a Federal bill to restrict the sale of 
patent medicines containing habit-forming 
drugs? It is of course to the interest of every 
druggist to create a lasting demand for his 
article. There is obviously not so much profit 
in a medicine that cures as in one that becomes 
indispensable. Hence arises the great induce- 
ment, from the druggist's point of view, in 
soothing- syrups and the like. In this country 
all druggists, wholesale and retail, are organ- 
ized, and the moment a bill is brought up any- 
where to correct the evil in question, there is 
enormous pressure of business interests to se- 
cure its dismissal or satisfactory amendment. 

To show the essential selfishness of their 
position, it is only necessary to quote a few of 
the arguments used against me before the Con- 
gressional Ways and Means Committee when I 
was making a plea for the regulation of the traf- 
fic in habit-forming drugs. They claimed that 
registration of the quantities of opiates in pro- 
prietary medicines would entail great bother 
and added expense, that these drugs are usually 
combined with others in such a way as to result 
in altering their effect on the user, and that, any- 



THE PERIL OF THE DRUG HABIT 13 

way, so small an amount of these drugs is used 
that it cannot create a habit. Now, as a matter 
of fact, the combination of medicines in these 
remedies makes not the slightest difference in 
the physiological action of the drug; further, it 
is found that, just as With the drug itself, the 
dose of these compounds must be constantly in- 
creased in order to confer the same apparent 
benefit as in the beginning ; and finally, it is well 
known that what creates the craving is not the 
quantity of the drug, but the regularity with 
which it is taken. A taker of one eighth of a 
grain of morphine three times a day would ac- 
quire the habit just as surely as a man who took 
three grains three times a day, provided the 
latter could tolerate that quantity. 

The average opium-smoker consuming twenty- 
five pills a day gets only the equivalent of about 
a quarter grain of morphine taken hypodermi- 
cally or of a half grain taken by the mouth. A 
beginner could not smoke a quarter of that 
quantity, but still he acquires the habit. Any 
amount of the drug which is sufficient to allevi- 
ate pain or make the taker feel easier is suf- 
ficient to create a habit. A habit-forming drug 
having no curative properties whatever is put 
into a medicine merely for the purpose of mak- 



14 HABITS THAT HANDICAP 

ing the taker feel easier. One wholesale house 
alone prepares and sells six hundred remedies 
containing some form of opiate. Most of the 
cases of the cocaine habit have been admittedly 
created by so-called catarrh cures, and these 
contain only from two to four per cent, of co- 
caine. In the end, the snuffer of catarrh pow- 
ders comes to demand undiluted cocaine; the 
taker of morphine in patent medicines, once the 
habit is formed, must inevitably demand un- 
diluted morphine. 

This easy accessibility of drugs in medic- 
inal form is more dangerous than moralists 
care to admit. The reason why opium- 
smoking has been, up to the present, less prev- 
alent in the United States than in China and 
some other countries is probably that the 
preparation of it and the machinery for taking 
it are not convenient. If opium-smoking had 
been generally countenanced in America, if 
the sale of the pure drug had been for genera- 
tions permitted here, as it has been in China, 
if houses for its sale and preparation had 
been found everywhere, if its social aspects had 
been considered agreeable, if society had put the 
stamp of approval upon it, opium-smoking 
would be as prevalent here as it has been in 



THE PERIL OF THE DRUG HABIT 15 

China. Our human nature is essentially little 
different from that of the Chinese, but lack of 
opportunity is everywhere recognized as a great 
preservative of virtue. Due allowance being 
made for the difference of moral concepts, our 
standards of morality and honesty and virtue 
are certainly no higher than those of the Chi- 
nese. Thus, were the conditions the same in 
both cases, there is no reason to suppose that 
opium would not be smoked here as much as 
there ; but fortunately it has not yet become thus 
easy, convenient, and agreeable, and conse- 
quently that particular phase of the evil has not 
yet reached overwhelming proportions. On the 
other hand, the alkaloids of opium administered 
hypodermically or as ingredients in many patent 
medicines are thus convenient, and as a result 
this phase of the evil has reached overwhelming 
proportions. Nor have we any cause for con- 
gratulation upon our particular form of the 
vice, for opium-smoking is vastly less vicious 
than morphine-taking. 

THE TRAFFIC IN OPIUM 

Something more is needed, however, than 
mere restriction of the sale of hypodermic 
syringes and patent medicines by any one legis- 



16 HABITS THAT HANDICAP 

lature or country. All persons who handle 
habit-forming drags should be made to give a 
strict accounting for them, otherwise the traffic 
can never be properly regulated. Four years 
ago, by special act of Congress, all importation 
of prepared opium and of crude opium designed 
for smoking purposes was prohibited. In the 
ample interval between the passage of the bill 
and its going into effect the importation of opium 
was simply phenomenal. By the time it went 
into effect the American dealers had learned the 
secret process of preparing opium for smoking, 
which had hitherto been known only in the 
Orient. Thereafter it was found that since re- 
sponsible importing houses were still at liberty 
to import crude opium in any quantity for gen- 
eral medicinal use, the retailers could buy and 
were buying from importers all the crude opium 
they wished and preparing it themselves with- 
out having in any way to account for the use 
they meant to make of it, although that use had 
now become illegal. The result was that the 
smoker could get opium more easily than before, 
since the secret process of preparing it had be- 
come known; and having no longer to pay the 
enormous tax on prepared opium, he got it much 
cheaper. In short, the only difference was that 



THE PERIL OF THE DRUG HABIT 17 

the Government lost about one million five hun- 
dred thousand dollars a year in revenue, while 
the vice was greatly increased. Thus the act 
had worked in precisely the opposite way from 
the intention of the f ramers, and all because men 
are permitted to handle opium without account- 
ing -for it. Until there is such an accounting, 
there can be no real regulation of the opium 
trade. 

Congress has just passed a bill aiming to reg- 
ulate the traffic in habit-forming drugs. I wish 
to go on record here as saying that this bill will 
not accomplish its purpose, and should be fur- 
ther amended to prove effective. But it will be 
only a matter of time when there will be amend- 
ments proposed, which, if adopted, will create 
legislation on this subject worth while. 

The history of the Opium Commission ap- 
pointed by Mr. Taft is sufficient to show how 
any less comprehensive regulation would act. 
When Mr. Taft was Governor-General of the 
Philippines, he found that an enormous quantity 
of opium was being smoked by the natives and 
the large Chinese settlement, of whom it was es- 
timated that fifty-five thousand were smokers. 
He appointed a commission headed by Bishop 
Brent, now stationed at Manila, who has since 



18 HABITS THAT HANDICAP 

headed two international opium conferences, at 
Shanghai in 1909 and at The Hague in 1911. 
Mr. Taft sent the commission into the most im- 
portant opinm-producing countries to find out 
how they were dealing with the problem and 
what progress was being made toward decreas- 
ing the use of the drug. The nearest approach 
they found to a reform was the method of the 
Japanese in their newly acquired island of For- 
mosa. Japan, with the most stringent regula- 
tion of the sale of opium in the world, had made 
it a government monopoly in Formosa, had com- 
pelled the registration of all smokers, and was 
gradually lessening the amount which each 
smoker could buy. After the exhaustive report 
of the commission, our Government adopted the 
same tactics in the Philippines. To the surprise 
of the officials, they found that out of the fifty- 
five thousand opium-smokers they could obtain a 
registration of only from ten to twelve thou- 
sand, which meant that the great majority were 
getting smuggled opium. By special act of Con- 
gress the authorities at Manila were allowed to 
stop the importation of opium entirely. But 
this, while it meant a great loss of revenue to the 
local government, apparently did not lessen the 
amount smoked. After the sale was stopped, 



THE PERIL OF THE DRUG HABIT 19 

there were virtually no voluntary applications 
for opium treatment, as there must have been 
if anybody's supply had been cut off, which con- 
clusively showed that nobody had discontinued 
the habit merely because importation had been 
discontinued. Stopping importation, then, is a 
farce, unless at the same time there is rigid gov- 
ernmental control in those countries that pro- 
duce or import the drug. And, therefore, un- 
less there should be a cooperation of all govern- 
ments, it is futile to try to regulate the traffic. 
As long as people can get opium, they will 
smuggle it. 

It has been demonstrated to be quite practi- 
cable for all the opium-producing countries to 
make the drug a government monopoly ; it would 
be equally practicable for them to sell directly 
to those governments that use it for govern- 
mental distribution. The only obstacle to an 
international understanding is that the produc- 
ing countries know very well that government 
regulation would materially lessen the sale of 
the drug. Within the borders of our own coun- 
try such a system would simplify rather than 
complicate present conditions. We have to-day 
along our frontier and in our ports inspectors 
trying to stop the illicit traffic in opium, and the 



20 HABITS THAT HANDICAP 

money thus spent by our Government would be 
more than sufficient to handle and distribute all 
of the drug that is needed for legitimate pur- 
poses. Any druggist could of course continue 
to buy all that he wished, but he would have to 
account for what he bought. The drug would 
serve only its legitimate purpose, because the 
druggist could sell it only on prescription. 
This would at once eliminate the gravest feature 
of the case, the indiscriminate sale of proprie- 
tary and patent medicines containing small 
quantities of opium. The physician would thus 
have to shoulder the entire responsibility for 
the use of any habit-forming drug. With the 
Government as the first distributor and the 
physician as the last, the whole condition of 
affairs would assume a brighter aspect, for it 
would be a simple matter to get from the physi- 
cian a proper accounting for what he had dis- 
pensed. Thus the new crop of users would be 
small, and less than ten per cent, of the opium at 
present brought into this country would be suf- 
ficient to meet every legitimate need. 

THE HABIT-FORMING DRUGS 

The important habit-forming drugs are 
opium, cocaine, and the small, but dangerous, 



THE PERIL OF THE DRUG HABIT 21 

group of hypnotics. These last — trional, ve- 
ronal, sulphonal, medinal, etc. — are chiefly coal- 
tar products, and are not always classified as 
habit-forming drugs, but they are such, and 
there are many reasons why the sale of them 
should be scrupulously regulated. The opium 
derivatives go under the general head of nar- 
cotics. Morphine is the chief active principle, 
and codeine and heroin are the chief deriva- 
tives of morphine. Codeine is one eighth the 
strength of morphine; heroin is three times as 
strong as morphine. 

Though the general impression is otherwise, 
the users of heroin acquire the habit as quickly 
and as easily as if they took morphine. Many 
cough and asthma preparations contain heroin, 
simply for temporary alleviation, since, like 
opium, it has no curative power whatever. 
From time to time I have had to treat cases of 
heroin-taking in which the victims had thought 
to satisfy their need for an opiate without form- 
ing a habit. In the cases where it was given by 
prescription, it was so given by the physician in 
the sincere belief that it would not create a 
habit. All this despite the fact that heroin is 
three times stronger than morphine, and despite 
the fact that physicians know that anything 



'22 HABITS THAT HANDICAP 

which will do the work of an opiate is an opiate. 
Codeine, notwithstanding the fact that it is 
weaker than morphine, is likewise habit-form- 
ing; yet doctors prescribe it on account of its 
relative mildness, even though they know that 
it is the cnmnlative effect of continued doses, 
and not the quantity of morphine in the dose, 
which results in habit. As with morphine, 
use either of these drugs effectively means in 
the long run the necessary increase of the dose 
up to the limit of physical tolerance. 

The most harmful of all habit-forming drugs 
is cocaine. Nothing so quickly undennines its 
victim or provides so short a cut to the insane 
asylum. It differs from opium in two im- 
portant ways. A man does not acquire a habit 
from cocaine in the sense that it is virtually im- 
possible for him to leave it off without medical 
treatment. He can do so, although he rarely 
does. On withdrawal, he experiences only an 
intense and horrible depression, together with a 
physical languor which results in a sleepiness 
that cannot be shaken off. Opium withdrawal, 
on the other hand, results in sleeplessness and 
extreme nervous and physical disorder. In ac- 
tion, too, cocaine is exactly the opposite of 
opium, for cocaine is an extreme stimulant. 



THE PERIL OF THE DRUG HABIT 23 

Its stimulus wears off quickly and leaves a cor- 
responding depression, but it confers half an 
hour of capability of intense effort. That is 
why bicycle-riders, prize-fighters, and race- 
horses are often doctored, or "doped," with 
cocaine. When cocaine gives out, its victim in- 
variably resorts to alcohol for stimulus; alco- 
holics, however, when deprived of alcohol, gen- 
erally drift into the use of morphine. 

The widespread use of cocaine in the com- 
paratively short period of time since its dis- 
covery has been brought about among laymen 
entirely by patent-medicine preparations con- 
taining small quantities of it. These have been 
chiefly the so-called catarrh cures, which of 
course cure nothing. With only a two or four 
per cent, solution, they have created a craving, 
and in the end those who could do so have pro- 
cured either stronger solutions or the plain 
crystal. As with the other drugs, in order to 
maintain the desired result the dose must be in- 
creased in proportion as tolerance increases. 
Wherever the sale of patent medicines has been 
restricted to those presenting a physician's pre- 
scription, the consumption of cocaine has at once 
been lessened. A man cannot afford to get a 
physician's prescription for a patent medicine; 



L'4 HABITS TKAT HANDICAP 

and even if he could, the reputable phys: sian re- 
fuses to prescribe one that contains cocaine, 
THien an overseer in the South will deliberately 
put cocaine into the rations of his negro labor- 

i in order to get more work out of them to 
meet a sudden emergency, it is time to have 
some policy of accounting for the sale of a drug 
like cocaine. 

It ifi alt : ^ztremely important to regulate the 
sale of the hypnotic coal-tar derivatives. All 
the group of hypnotics should be buyable only 
on a physician's prescription. They all disturb 
heart action and impoverish the blood, thereby 
producing neurotics. No physician, without 
making a careful examination, will assume the 
responsibility of prescribing for a man who 
c : me a to him in pain, yet a druggist does so con- 
stantly. He knows nothing of the customer's 
idiosyncrasy; that, for instance, an amount of 
" : onal which would not ordinarily affect a child 
may create an intense ne: : us lis order in a par- 
ticular type of adult. To the average druggist 
a heads L i : : nly a headache ; he does not know 
that what will alleviate one kind of headache is 
exceedingly bad for another kind, and further- 
more it is not his business to warn the customer 
that a particular means of headache alleviation 



THE PERIL OF THE DRUG HABIT 25 

may perhaps make him a nervous wreck. The 
patient usually has the same ignorance. In a 
case which was once brought to my attention, a 
girl swallowed nine headache powders within 
one hour. Had there been ten minutes ' delay 
in summoning a doctor, she would have died ; as 
it was, she was seriously ill for a long time. 

These, then, the narcotics, cocaine, and the 
hypnotics, are the chief habit-forming drugs. 
They form habits because it is necessary to in- 
crease the dose in order to continue to derive 
the apparent benefit obtained from them in the 
beginning, and because, when once the habit is 
set up, it cannot be terminated without such 
acute discomfort that virtually no one is ever 
cured without medical help. In drug addictions 
the condition of the patient is not mental, as 
is generally supposed, but physical. Definite 
medical treatment to remove the effects of the 
drug itself is imperative, whether the victim be 
suffering from the drug habit alone or from that 
habit in a body otherwise physically disordered. 
With regard to the cure of the habit, as in the 
case of the conditions which permit of its being 
acquired, it may justly be said that the victims 
have been unfairly treated. 



26 HABITS THAT HANDICAP 

THE NEED OF CONTROL BY THE GOVERNMENT AND 
BY PHYSICIANS 

The prevalence of the drug habit, the magni- 
tude of which is now startling the whole civilized 
and uncivilized world, can be checked only in one 
way — by controlling the distribution of habit- 
forming drugs. With the Government as the 
first distributor and a physician as the last, 
drug-taking merely as a habit would cease to be. 
If physicians were made accountable, they would 
use narcotics, hypnotics, and cocaine only when 
absolutely necessary. Nobody should be per- 
mitted to procure these drugs or the means of 
using them or any medicines containing them 
without a doctor's prescription. By such re- 
striction the intense misery due to the drug 
habit would be decreased by nine tenths, indeed, 
by much more than this ; for when a physician 
dares no longer to be content with the mere alle- 
viation of pain, which is only nature's way of 
announcing the presence of some diseased con- 
dition, he will seek the more zealously to dis- 
cover and remove its cause. 



CHAPTER II 

THE NEED OF ADEQUATE SPECIFIC TREATMENT FOR 
THE DRUG-TAKER 

THE Internal Revenue Reports are the only 
index to the extent of the drug consump- 
tion in the United States. They show for years 
past an annual increase in the importation of 
opium and its derivatives and cocaine, and for 
last year a very marked increase over that of 
any preceding year. This is not due to the in- 
crease in population; our immigrants are not 
drug-takers. Among the thousands of drug- 
users that I have treated or known, I have never 
seen an Italian, a Hungarian, a Russian, or a 
Pole. Moreover, I have met with only four 
cases of drug-taking by Hebrews. Few Jews — 
except in the under-world — acquire the habit 
knowingly. It may become fastened upon them 
through the use of a medicine the danger of 
which they do not realize, but, once freed, they 
will not again come under its power. The prac- 
tical sagacity of their race is their surest safe- 
guard. 

27 



28 HABITS THAT HANDICAP 

"What is commonly spoken of as the "Ameri- 
can type," highly nervous, living under pres- 
sure, always going to the full limit, or beyond, 
is peculiarly liable to disorders that lead to the 
habitual use of drugs. We are all hypochon- 
driacal by nature, prone to ''take something" 
whenever we feel badly. Lack of opportunity 
alone, of knowledge of what to take and how to 
procure it, has saved many a person under se- 
vere physical or mental strain from recklessly 
resorting to drugs. Since the passage of the 
Pure Food and Drugs Act, which was intended 
to protect the public by requiring the express 
statement of any dangerous ingredients in a 
compound, the sale of preparations containing 
habit-forming drugs has preceptibly increased. 
It seems a just inference that the information 
given, instead of serving as a warning to the 
unwary, has been chiefly effective in pointing 
out a dangerous path to many -who otherwise 
would not have known where to find it. 

Women, it should be said, though constitu- 
tionally more liable than men to feel the need 
of medicines, form the lesser portion of the 
drug-taking class. In the beginning their ad- 
diction is due almost exclusively to a physician's 
prescription, except in the under-world. 



TREATMENT FOR DRUG-TAKER 29 

The habitual users of drugs in the United 
States come from every grade of society. Pro- 
fessional men of the highest responsibility and 
repute, laborers wearying of the dullness in a 
mining-camp, literary men, clergymen, newspa- 
per men, wire-tappers, shoplifters, vagrants, 
and outcasts — all are among the number. 
Strangely assorted as they are, they become yet 
more strangely alike under the influence of the 
common habit. Shoplifting is not confined to 
the professional thief; it is noticeable in many a 
drug-user who has had every moral and worldly 
advantage. 

The major part of the habit-forming drugs 
used in the United States is consumed by the 
under-world. It would be impossible to calcu- 
late the extent of their influence. Many a 
record of heinous crime tells of the stimulus of 
a drug. But when the school-children in some 
of our larger cities are found to be using co- 
caine, and able to buy it at will, the limit of tol- 
erance has surely been reached. 

THE DRUG- TAKING PHYSICIAN", NURSE, AND 
PHARMACIST 

Among the widely varying classes of drug- 
users, three in particular are a source of the 



30 HABITS THAT HANDICAP 

gravest danger: the drug-taking physician, 
nurse, and pharmacist. To realize this, one has 
merely to recall that the drug-taker is a con- 
firmed evader of responsibility; and the physi- 
cian, of all men, is in a responsible position. 
He must not forget or break his appointments ; 
he must realize the effects of the medicines he is 
prescribing; if a surgeon, his work must never 
be below its best. But the proportion of physi- 
cians that I have treated, or consulted with, 
suggests one specially grave danger. It is a 
characteristic of the drug-taker, no matter who 
he is or how he acquired the habit, on the small- 
est excuse to advise others to take the drug 
whenever pain or fatigue gives the slightest oc- 
casion for it. While he grows callous to every- 
thing else, he has an abnormal sympathy with 
suffering. Thus it will readily be seen that 
there are few more dangerous members of so- 
ciety than the physician who is addicted to a 
drug. 

The fact that there are not more drug-taking 
doctors speaks volumes for the high character 
of the profession. The physician has such 
drugs constantly at hand. The more a man 
knows of their insidious action and the more he 
handles them, the more cautious he feels him- 



TREATMENT FOR DRUG-TAKER 31 

self to be, and the more confident that he can 
discontinue the use of them whenever he chooses. 
Any fear that the layman may have of them is 
due less to the dread of being personally over- 
come than to the mystery which surrounds 
them; but for the physician they have no such 
mystery. Furthermore, by the nature of his 
calling he is peculiarly exposed to the need of 
such drugs. He is often under excessive phys- 
ical and nervous strain not only because he is 
unable to arrange his work so as to prevent 
periods of too great pressure upon his time and 
strength, but also because in a unique manner he 
puts his heart into it. 

An even greater danger, in some respects, is 
the drug-taking professional nurse. Whatever 
has been said of physicians both in the way of 
extenuation and of warning may be repeated of 
nurses. They have the same exposure to the 
habit, and, once addicted, are likely to exhibit 
signs of irresponsibility. They are more dan- 
gerous in that their opportunity for mischief is 
greater, since they are closer to the patient and 
able to thwart the doctor's orders with perfect 
freedom. "I have had several nurses on this 
drug case," a doctor once said to me, "and I 
find that they have all smuggled morphine to 



32 HABITS THAT HANDICAP 

my patient." This was, no doubt, an excep- 
tional case, bnt the fact remains that nnrses, be- 
cause of their close alliance with druggists and 
doctors, find it comparatively easy to purchase 
drugs and hypodermics at any drug store with- 
out causing the slightest suspicion or reproof. 
Nor should one censure them too severely for 
clandestine compliance with the demands of a 
patient. It should not be overlooked that the 
nurse, in being paid by the patient and not by 
the doctor, is ordinarily subjected to great 
pressure when the patient clamors for mor- 
phine. In such circumstances the protection of 
a physician's monopoly of the drug would be 
most welcome. But how much worse is the 
pressure when the well-intentioned nurse also 
is a drug-taker ! The morphinist has an abnor- 
mal sympathy with those who have undergone 
or are undergoing experiences similar to his 
own, and there is no stronger bond than that 
which unites two morphine victims. As a mat- 
ter of the most elementary precaution for all 
concerned, no nurse should under any condi- 
tions be allowed to buy habit-forming drugs. 

Another kind of drug-taker against whom 
physicians' distribution would be a safeguard, 
and the only safeguard that can be devised, is 



TREATMENT FOR DRUG-TAKER 33 

the pharmacist. The contingency of a drug- 
taking pharmacist, perhaps more than anything 
else, will bring, sharply home to the average 
man the menace of morphine when nsed by a 
professional person. By reason of closer and 
more personal observation one may feel rashly 
confident of his ability to detect when a doctor 
or a nurse is "queer," but generally the patron 
of a drug store has no such opportunity for ob- 
servation. Addiction to a drug incapacitates 
the pharmacist for filling prescriptions. Often 
the slightest deviation from a precise formula 
in either quantity or ingredient is of the grav- 
est consequence, and hence the utmost care 
should be used to insure the scrupulousness of 
one on whom such responsibility rests. As 
long as he is accountable to no one, or even ac- 
countable to the Government only on a business 
basis, there can be no safety for the public. If 
he may sell to any purchaser other than a physi- 
cian, he may always supply his own wants. But 
if he has to account to a physician for the en- 
tire amount of habit-forming drugs that he dis- 
tributes, any leakage may quickly be detected 
by the man who more than any one else can be 
relied upon to stop such a leakage promptly and 
sternly. A pharmacist should be allowed to 



34 HABITS THAT HANDICAP 

dispense habit-forming drugs only on a physi- 
cian's prescription. 

The physician should be limited as to his au- 
thority not only for prescribing such drugs, 
but, as the Boylan Act provided, there must be 
a careful accounting on his part for all such 
drugs administered or given away. In other 
words, he must account for all such drugs which 
he buys for office use, and he cannot prescribe 
such drugs except under certain definite limita- 
tions. 

METHODS OF TREATMENT : "THE HOME CUBE" 

For many years only two methods of dealing 
with the drug habit were known. They con- 
tinue to be the only ones in general use to-day. 
They are the "home cure" and the sanatorium 
method. Neither is in any proper sense a 
treatment or anything more than a process of 
substitution and deprivation. 

In many of the periodicals and daily papers 
are carefully worded advertisements setting 
forth that a man may be cured of a drug habit 
quickly, secretly, painlessly, and inexpensively. 
These are written by people who thoroughly un- 
derstand the mental and physical condition of 
the drug-taker. In almost all cases he wishes 



TREATMENT FOR DRUG-TAKER 35 

to be freed from the habit, but at the same time 
to avoid the disgrace of being classed with 
" drug-fiends ' ' ; he is unwilling that even his 
family or his intimates should know of his con- 
dition. He has an exaggerated sensitiveness to 
pain, upon which also the advertisement relies. 
Furthermore, attention is directed to the fact 
that the patient may take the alleged remedy 
without spending much more money than he has 
been spending for the drug itself, naturally a 
powerful appeal to a man of limited means. 
Moreover, the people who take these " cures' ' 
are generally those who are unable to consider 
the expense of leaving home. That the adver- 
tisement is very alluring to the average drug- 
taker is shown by the fact that in my entire 
practice I have encountered few patients who 
have not at some time or other taken a home 
cure. 

A minister wrote to me the other day beg- 
ging me to cure a fellow-minister of the cure 
habit. His friend had had occasional attacks 
of renal colic, and a physician had eased their 
acuteness with a hypodermic. The patient of 
course knew what he was taking, and since he 
was forced to consider the cost of the physi- 
cian's visits for the mere administration of the 



36 HABITS THAT HANDICAP 

hypodermic, lie naturally procured his own out- 
fit, and in a short time was using it regularly 
upon him self. TVhen he found that he could not 
leave off the practice he entered into correspond- 
ence with a succession of "home-cure" adver- 
tisers, whose clever use of the word " privacy " 
offered a hope that his condition might be con- 
cealed from his congregation. For ten years he 
had been undergoing the cures, and during all 
this time had been forced to take a regular 
dosage of the so-called remedies. 

Before the passage of the Pure Food and 
Drugs Act the ingredients of such remedies 
were not stated. The patient seems never to 
have suspected the truth — that the bottle con- 
tained the very drug he had been taking, its 
presence disguised by added medicines. In cer- 
tain instances the makers boldly advertised that 
a trial bottle would be sufficient to prove clearly 
that the taker could not get along without using 
his drug. Xow that the law compels a list of 
dangerous drugs on the label, the cures proceed 
admittedly by a reductive principle. The pa- 
tient graduates from a number one bottle to a 
number two, containing less opium, and so on, 
until finally he is supposed to be cured. The 
proprietors of these cures make a great deal of 



TREATMENT FOR DRUG-TAKER 37 

capital out of the fact that the reduction is so 
gradual that the taker experiences no discom- 
fort. This consideration is highly effective, 
for while it irresistibly appeals to the mor- 
bidly sensitive morphinist, it also makes him 
comprehend, as time goes on, why the proc- 
ess of cure is so slow. It is hardly necessary 
to state that the final stage is almost never 
reached. 

Almost without exception, the basis of restor- 
ation to health is the perfect elimination of the 
effects of the drug. It should go without say- 
ing that it is impossible to eliminate the effects 
of opium with opium or to find any substitute 
for opium that is not itself opium. At the In- 
ternational Opium Conference in China I ex- 
hibited seventy-six opium-cures which I had had 
analyzed and found to contain opium ; and as a 
consequence of the Pure Food and Drugs Act 
all the American " cures' ' announced on their 
labels that they also contained it. Thus it is 
easy to see why the sale of these cures had al- 
ways greatly increased wherever the rigid en- 
forcement of anti-opium enactments had closed 
up the customary sources of habit-forming 
drugs. 

Up to the passage of the act, however, the 



38 HABITS THAT HANDICAP 

presence of opium in the American cures was 
concealed, and their formulas were kept secret ; 
and hence all of them, by the very nature of the 
case, were put forth either by irresponsible per- 
sons or by persons outside the pale of the pro- 
fession ; for one of the pledges given by a physi- 
cian is that he will not patronize or employ any 
secret treatment, and that he will give to the 
profession whatever he finds to be of benefit to 
his fellow-men. 

In very rare cases these home cures have been 
able to relieve a man of strong will power, with 
the added assistance of a regimen for building 
up his bodily tone. But these cases have been 
so infrequent as to be virtually negligible, for 
to administer the treatment successfully de- 
mands from the patient the exercise of precisely 
that power of self-control the loss of which 
drove him to the cure in the first place. If 
there ever was any curative property in one 
of these so-called cures, a man could not be 
benefited unless he were under constant super- 
vision. A treatment of this sort must, except 
in case of a miracle, be administered by another 
and under continuous medical surveillance. A 
man addicted to a drug, be he physician or 
longshoreman, in a short time becomes utterly 



TREATMENT FOR DRUG-TAKER 39 

unable to deal justly with himself, for it is the 
nature of the drug to destroy his sense of re- 
sponsibility. 

THE SANATORIUM TREATMENT 

Besides the home cure there was, and is, the 
sanatorium treatment. Unlike the former, this 
was first established and carried on by trust- 
worthy medical men, who depended for their 
support upon the patients of reputable doctors. 
A physician who had a morphine patient was 
obliged to send him to a sanatorium because 
there was nothing else to be done with him; 
elsewhere no course of treatment under con- 
stant surveillance could be given. It afforded 
the only opportunity of carrying the patient 
through the long period of gradual reduction 
which was then the only known treatment. 
Thus there was nothing optional about the mat- 
ter ; the physician could not recommend a home 
cure, and the only means of approximating sys- 
tematic treatment was the sanatorium. Fur- 
thermore, those relatives and friends who knew 
of the patient's condition were anxious that he 
should go to one, since they realized the in- 
creasing awkwardness of keeping him at home. 
In many cases, indeed, they even went so far as 



40 HABITS THAT HANDICAP 

to resort to means of coniniitinent, if they failed 
to get his voluntary cooperation. It is due to 
the ease with which this type of patient can be 
committed that the State of Connecticut, for in- 
stance, abounds in sanatoriirms. In that State, 
when a patient has entered one of them, he can 
often be detained there virtually at the pleasure 
of his relatives and friends. 

The method of treatment at most of the sana- 
toriums is like the home cure, except that it is 
under surveillance: that is, it is merely one of 
gradual reduction accompanied by an upbuild- 
ing of bodily tone. The morphine-taker with 
means and time at his disposal will stay in a 
sanatorium as long as he can be made comfort- 
able. This shows that whatever reduction he 
has undergone is extremely slight: for gradual 
reduction, when it is carried to any extent, sets 
up a highly neiwous state, together with in- 
somnia and physical disturbance. The pa- 
tient, as is often said, has an exaggerated dread 
of discomfort, and will not, if he can help it, 
endure it at all. Unless he is committed, he 
transfers himself to another sanatorium the 
moment he ceases to be made comfortable. I 
had one patient whose life had been a continu- 
ous round of sanatoriums. He would stav in 



TREATMENT FOR DRUG-TAKER 41 

one place until the point was reached where dis- 
comfort was in sight, and then remove to an- 
other, remaining there for a similar period, and 
then to another, and so on, until he had finished 
a long round of sanatoriums to his taste in 
America and Europe. Then he would begin all 
over again. 

A patient of mine who had visited eight dif- 
ferent sanatoriums in the vicinity of New York 
told me that in America the sanatorium treat- 
ment of neurological patients was divided into 
three great schools: the "forget-it" system, the 
1 6 don't- wo rry" system, and the " brace-up' ' 
system. Any nervous invalid who has stayed 
much at sanatoriums will appreciate the humor 
of this classification. 

The gravest aspect of these long stays at a 
sanatorium is the unavoidable colonization. 
Picture to yourself a group of from half a 
dozen to fifty morphine patients, eating to- 
gether, walking together, sitting on the ver- 
anda together, day in and day out. In this 
group are represented many different tempera- 
ments and many different stations of life, from 
the gambler to the clergyman. All the more 
on this account is there a general and eager dis- 
cussion of previous history and present situa- 



42 HABITS THAT HANDICAP 

tion. For where the alcoholic is quite indiffer- 
ent, the morphine victim has an insatiable in- 
terest in symptoms. He has also an excessive 
sympathy with all who have been through the 
same mill with himself. Thus, in a matter 
where individual and isolated treatment is im- 
perative, most sanatoriums deal with patients 
collectively. Furthermore, these are peculiarly 
a class of unfortunates who ought never to be- 
come acquainted. Whatever moral restraint 
the habit has left in a man is completely relaxed 
when he hears constant bragging of trickery 
and evasion and has learned to envy the clev- 
erness and resource so exhibited. The self- 
respect and pride which must be the main fac- 
tors in his restoration are sometimes fatally 
weakened. Colonization should be restricted 
to the hopeless cases, and to them only because 
it is unhappily necessary. 

FAILURE OF I HE REDUCTION METHOD 

All this, moreover, is never, or almost never, 
to any purpose. As the uncomfortable patient 
will move if possible, it is naturally the business 
of the sanatorium to keep him from being un- 
comfortable. The method of reduction, there- 
fore, is rarely carried out to the point where it 



TREATMENT FOR DRUG-TAKER 43 

would do any good, even if good were thus pos- 
sible. But it is not possible. In the first place, 
lessening the dose is of little avail; there is as 
much suffering in the final deprivation of a cus- 
tomary quarter of a grain as of twenty grains. 
In the second place, it cannot be ascertained by 
gradual reduction whether there is any disa- 
bility which makes morphine necessary, since 
no intelligent diagnosis can be made so long as 
a patient is under the influence of the smallest 
quantity of the drug. Obviously, the first step 
in taking up a case should be to discover 
whether any such disability is present, and, if 
so, whether it is one that can be corrected; 
otherwise it may be a waste of time to try to 
correct it. The true physical condition of the 
patient, which should be considered before a 
long course of treatment is undertaken, can sel- 
dom be discovered by the reduction method. 

The best doctors have always felt that they 
could not afford to lend their names to any in- 
stitutions or sanatoriums except those which re- 
stricted themselves to mental cases. Yet these 
home cures and sanatoriums, unscientific and 
ineffective as they were, have offered to the vic- 
tims of the drug habit the only hope they could 
find. The investigations begun by Mr. Taft in 



44 HABITS THAT HANDICAP 

the Philippines extended over considerable time 
and cost two hundred and fifty thousand dol- 
lars, but. although furthered in every way by 
the whole world, they failed to discover a defi- 
nite treatment for the drug habit. It was gen- 
erally believed by physicians that there was no 
hope for the victims of it. 

COST OF THE DEUG HABIT 

It may be noted that I have not dwelt upon 
the expense of the habit. This consideration 
may be omitted from the case. To the average 
victim, the cost of his drugs, no matter what 
he may have to pay for them, seems moderate. 
He is buying something which he deems a vital 
necessity, and which, moreover, he places, if a 
choice be required, before food,, drink, family, 
sleep, pleasures, tobacco — eveiy necessity or in- 
dulgence of the ordinary man. 

The real cost is not to the drug-taker, but to 
the world. If a human life be considered 
merely as a thing of economic value, an estimate 
may perhaps be made of the total loss due to 
the habit. % 

But the loss should not be reckoned in any 
such wav. It should rather be reckoned bv the 
great amount of moral usefulness and good 



TREATMENT FOR DRUG-TAKER 45 

that might be rendered to the world if these un- 
fortunates could be freed from their slavery, 
and by the actual harm being done by them, 
especially by those that are now loosely classed 
as criminals and degenerates. 

The retrieving of much of the waste of hu- 
manity may be accomplished by adequate treat- 
ment of the drug habit. 



CHAPTEE m 

THE DRUG-TAKER AND THE PHYSICIAN 

THE doctor who begins to take the drag in 
order to whip his nagging energies into 
new effort finds the habit fastened on him be- 
fore he realizes what has occurred. His en- 
deavors to reduce his daily dosage fail, and he 
becomes thoroughly enmeshed. His acquired 
tolerance for the drug has brought about so 
great a physical change that deprivation or even 
reduction of dosage is intolerable. Hundreds 
of cases where physicians had experimented 
with the drug with these disastrous results 
have been brought to my attention. 

No one shows less foresight, less apprecia- 
tion of the danger of tampering with drugs, than 
the physician himself. I am constantly amazed 
by the fact that any doctor will take even the 
slightest risk of becoming a drug-user. That 
many voluntarily incur the peril passes my un- 
derstanding. 

I have seen an astonishing number of physi- 

46 



DRUG-TAKER AND PHYSICIAN 47 

cians who for various physical reasons other 
than exhaustion and the need of stimulant con- 
sidered themselves eligible to experiment with 
drugs. It is a curious thing that, as a class, 
physicians and surgeons are themselves singu- 
larly averse to submitting to surgical operation, 
even when symptomatic indications strongly 
urge it. Why surgeons, in particular, should so 
generally dread the application of the knife in 
their own cases is a puzzle, for of course no 
class more thoroughly understands the need of 
surgery. I could mention many cases of this 
sort, but one in particular recurs to my memory. 
He was one of the most careful and best- 
informed doctors in the country, and he was not 
without a certain special knowledge of the peril 
involved in habit-forming drugs; but he suf- 
fered from a painful rectal trouble, and al- 
though he considered himself too intelligent a 
man to go too far with a dangerous substance, 
he did go too far. He had thought that he could 
leave drugs off whenever he desired; he found 
that he could not. 

THE PHYSICIAN" WHO TAKES DRUGS 

It is impossible to make even an approxi- 
mately accurate gmess at the proportion of 



— 



-» - 



±5 HABITS THAT HANDICAP 

tnysiiaans ~no are arag-a-sers. i.Triy^riTrr 
except A Xr~ York State AnysicAns :an A tain 

and At A a: laying A ens rive 5 open to any :et- 
alty Aiatsoever. rTri if AAr rttrtlaases are 
A::t.At to oAAal attention. No raedAal ::- 
iraAzatAn t:Aes :-n - :-:^Atance A drn^-taAAa' 

_ « _ — _ 

physicians or rr:Ades any rzedieal help tor 
:dezz. It is AgAy pro AAA Aat Ae Ne~ Y 
State IeAslaA:n may tzneoTer s :-rze A the :Ir 
taking doctors in that commonwealth, thong 
this is by no means certain, since legisla- 
tion in force in only one State cannot effectively 
pnt a stop to the illegal importation of habit- 
forming drugs from other States and countries. 
Pi: per restrictive legislation of sAAiently A. A 
scope would very prickly disclose every drug- 
taAng d: :t : i A Ae nation, az f: eithei : : i :e laira 
:•; :orre:t As playsi:al condition :r drive Ana 
from the profess! ml P : [ e : g e n oral regula- 
tion of the traffic and consumption of habit- 
fortzA^ Anas ~ A aid tienaend:nsly A freeing 
Ae rzedital profession front drtg-talters. Un- 
til tAs general regA-atlon eAsts n: general re- 
form will be possi I e . An ea : _ : 
every grain of AAlt-forrzAg drags ~AA A 
purchases, possesses, or a:lmiAsters. mast A 



DRUG-TAKER AND PHYSICIAN 49 

demanded of every physician in the United 
States before this evil can be entirely abated; 
and this accounting among physicians will be 
impossible until a similar accounting is de- 
manded of every grain imported, manufactured, 
and dispensed by wholesale and retail druggists. 

Concerning the extent of the hold which the 
drug habit has upon physicians I have had a 
rare opportunity to judge. Not only has my 
dealing with the drug habit been as exclusively 
as possible through the physician rather than 
through the patient, but the brevity of my treat- 
ment and the privacy that my patients are as- 
sured make it possible for many physicians who 
have become afflicted to come to me for relief 
without arousing in the mind of any one a sus- 
picion of the real cause for their brief absence. 
I therefore feel that I have a firm basis for accu- 
racy. 

It is the fear of disgrace which has driven 
hundreds of physicians from bad to worse with 
the drug habit : they have become apprehensive 
that any effort tending to their relief will un- 
cover their position to their families, associates, 
or patients, and thus bring ruin; so they have 
drifted on from bad to worse. Many who have 
not taken steps in time have reached the irre- 



50 HABITS THAT HANDICAP 

sponsible and hopeless stage. To the medical 
profession in general, as well as to the public, 
these men are a dreadful menace. 

ATTTTXTDE OF IKE PBOFZSSIOX 

I, a layman, have been greatly surprised that 
the medical world shows so little sympathy for 
these unfortunates. This seems to me to be 
specially reprehensible, since by this neglect 
they imperil the public. No greater service 
could be rendered to mankind by the medical 
profession than a concerted movement of the 
medical organizations toward the care and re- 
Kef of those among their drug-taking members 
who are still susceptible to help, and the ex- 
clusion from medical practice of those who 
have already gone too far to be reclaimed. 
Physicians of this class who are without means 
are specially entitled to sympathy and help, and 
this service will be of double value, for it will not 
onlv give them necessarv aid, but will notablv 
safeguard the public. No physician should be 
permitted to practise who is addicted to the use 
of habit-for min g drags or who uses alcoholic 
stimulants to excess ; but whatever is done in re- 
gard to these men should be accomplished with- 
out publicity and without any loss of pride or 



DRUG-TAKER AND PHYSICIAN 51 

standing. A doctor who has used either drugs 
or alcohol is much more to be pitied than 
blamed. 

The worthy practitioners — and there are 
many — who must resort to the use of drugs in 
order to enable them to practise despite some 
physical disability which cannot be eliminated, 
are no less numerous in proportion to the total 
number of physicians than similar cases are in 
relation to the total number of lawyers, mer- 
chants, or journalists, but because of the nature 
of their work, they are far more dangerous to 
the general public. It seems to me that there 
is in this fact — the existent, non-elimination of 
such perilous characters from the practice of 
medicine, and the obvious, very real necessity 
for such an elimination — a suggestion for some 
person of philanthropic mind. If the medical 
profession will not care for its own, then some 
one else must care for them. It occurs to me 
that among the people whose naturally fine im- 
pulses are leading them toward the endowment 
of institutions for the care of the aged maiden 
lady, or superannuated teachers, or others to 
whom fate has been unkind, there are many who 
might well consider this great need for the es- 
tablishment of a comfortable institution in this 



52 HABITS THAT HANDICAP 

country for the care of physicians who through 
no fault of their own have become unable to 
practise their profession with profit and effi- 
ciency. 

HOW THE DOCTOE BEC02>EES A DP/CG-TAKEE 

The doctor's yielding to the drug habit is a 
simple process, in ninety-nine cases out of a 
hundred unaccompanied hv anv unworthv tend- 
ency toward dissipation. In another yen of 
this book I make ritri^be reference to the fact 
that nowhere in the text-t :>oks by means of 
which the medical students of the world receive 
their education is any proper attention paid to 
the psychology of the drug habit. "VTe may as- 
sume that a doctor, having lost sleep because of 
a difficult case, is c : -fronted on his return to his 
office by another that demands immediate and 
skilful attention. He is tired and very likely 
he himself is ill. He cannot yield to his wor- 
ries or illness, as he would demand one of his 
patients to yield. He must "brace v.; He 

knows that in the stock of habit-forming drugs 
that he uses in his profession lies the material 
which will brace him up. He tries it ; it suc- 
ceeds. 

This doctor has begun to nibble at the habit. 



DRUG-TAKER AND PHYSICIAN 53 

and be does not know his danger. He himself 
does not believe that one or two or a few doses 
will fasten that habit upon him. He finds that 
a certain dosage produces the necessary desired 
result upon the first day ; he is stimulated to new 
efforts in behalf of his patients, and because 
those new efforts are the result of stimulation, 
they produce abnormal weariness. This ex- 
haustion must be overcome, and the result is an- 
other dosage of the drug; and this time the 
dosage must be larger than the first, for both 
his toleration for the drug and his weariness 
have increased. Only a few days of such ex- 
periences are necessary to fasten the habit upon 
him. 

I have often endeavored to imagine the thrill 
of horror which must chill a doctor's soul when 
he finds that this has happened. His position 
is a dreadful one. He has lost control. He 
must tell no one, for if he tells, disgrace and the 
loss of his means of livelihood will be but mat- 
ters of a short time. He knows nothing of any 
means of real relief ; he cannot help himself ; he 
is familiar with the dangers attendant on the 
fake cures which are widely advertised. He is 
confronted by a stone wall. He must either 
continue his dosage, thus enabling him to 



54 HABITS THAT HANDICAP 

keep on with his practice, or he must accept 
ruin and defeat; and to continue his dosage is 
the easiest thing imaginable, for the drug has 
been by law intrusted to his keeping and is close 
at hand. 

Another doctor who is specially susceptible to 
drug addictions is the one who has been accus- 
tomed to alcoholic stimulation. Any doctor 
who drinks alcohol, when he finds himself beset 
by arduous labor involving loss of sleep, or is 
confronted by cases of such a complex nature 
that they involve a great deal of mental worry 
on his part, is likely to drink more than usual. 
Thus work and worry, the two things which 
make him most liable to the evil effects of any 
stimulation, are likely to drive him directly into 
over-stimulation. 

Over- stimulation results in super-nervous ex- 
citation. The victim finds himself unable to 
sleep, he finds his hand tremulous, he finds his 
thoughts wool-gathering when they should be 
concentrating with intensity upon his work. In 
his pocket case there is his little morphine 
bottle; he knows its action, and when called to 
see a patient while under the influence of alco- 
holic stimulants he attempts to steady himself 
by the administration of a small dosage. 



DRUG-TAKER AND PHYSICIAN 55 

The result is virtually instantaneous and at first 
marvelously effective. He finds himself en- 
abled to do better work than he has done for 
years, and more of it. The remedy seems 
magical ; he tries it again and again. The man 
is lost. 

Such instances as these have produced the 
most utterly hopeless of the many cases of drug 
addictions among physicians with which I have 
come into contact. 

TYPES OP DRUG-USERS 

Specially numerous among drug victims are 
physicians in nose and throat work, where they 
make daily employment of cocaine solution. 
Some of the most desperate cases of drug habit 
that I have ever seen among physicians have 
come from this class, made familiar with the 
constant use of the drug by the necessity for 
continually administering it to their patients. 

Another physician who is specially liable is 
the man who suffers severe pain from a physical 
cause that he knows can be removed only by re- 
sorting to surgery. The average doctor will 
postpone a surgical operation upon himself until 
his condition has long passed the stage that he 
would consider perilous to any of his patients. 



56 HABITS THAT HANDICAP 

While lie postpones it he is suffering, and while 
he suffers he may be more than likely to con- 
tinue his practice through reliance upon the 
stimulation and pain-deadening qualities of 
habit-forming drugs, concerning the true and 
insidious nature of which he usually knows no 
more than the average layman. 

There have been a few cases of physicians 
who have yielded unworthily to drugs and opi- 
ates as a means of dissipation. I have known 
some physicians, for example, who have been 
opium-smokers. In the United States the 
opium-smoker is invariably unworthy. Not 
long ago the New York police raided the apart- 
ment of a physician where were found thirty or 
forty opium-pipes and more than a hundred 
pounds of opium, either crude or prepared for 
smoking. I have known fewer than half a dozen 
physicians whose drug vice was purely social, 
however. The victims of drug habit who 
achieved it through a tendency toward dissipa- 
tion are almost invariably denizens of the un- 
der-world; and if it were not for the fact that 
the contagion of their vice may spread, they 
might well be permitted by society to drug them- 
selves to death as speedily as possible. 

We shall entirely disregard the physician 



DRUG-TAKER AND PHYSICIAN 57 

who becomes addicted to the use of drugs 
through unworthy tendencies, and consider 
only the dangers to the profession and the pub- 
lic latent in the case of the physician who be- 
comes addicted in the less reprehensible, but 
more dangerous, manner that I have indicated. 
Not only will such a drug addiction injure the 
doctor's practice and threaten his career, but it 
will surely constitute a threat against the wel- 
fare of his patients not included in the possi- 
bility that through it he may miss engagements, 
write improper prescriptions, and make mis- 
takes of many kinds. 

THE DKUG-TAKING PHYSICIAN A MENACE 

A very serious danger lies in the psychology 
of drug addictions. The person who has taken 
a habit-forming drug for the purpose of reliev- 
ing his own pain, and through it has found that 
relief which he sought, is almost certain to be- 
come abnormally sympathetic to the suffering 
of others. It is a curious fact that this doctor 
will be more than likely to administer the drug 
he uses to his patients, not with malicious, but 
with probably friendly, intent, and that he will 
feel no scruples whatsoever in acting as a go- 
between for drug-users in general who find 



58 HABITS THAT HANDICAP 

themselves unable to obtain supplies easily. 
He will do what he can to help confirmed users 
to obtain their drugs, even if he makes no profit 
out of it. He will write prescriptions for them 
in evasion, if not in violation, of the law. It is 
a curious and tragic fact that the drug-taking 
doctor will spread the habit in his own family. 
There have been many instances in my hos- 
pital when I have had a physician and his wife 
as patients at the same time and on the same 
floor. In every one of these instances the drug 
addiction of a wife has been the direct result of 
constant association with the drug-addicted 
husband. No more dangerous detail exists in 
the psychology of drug-users than their almost 
invariable tolerance for the habit in others and 
their sympathetic willingness to promote its 
spread among those who suffer pain. In the 
under-world the drug habit never travels alone. 
Through it the woman who is a drug-user holds 
the man whom she desires ; through it the male 
drug-taker holds the woman whose companion- 
ship he finds agTeeable. It is a curious fact 
that while in the under-world the drug habit has 
become a social vice, especially in the case of 
cocaine, and is frequently a proof of mixed sex- 



DRUG-TAKER AND PHYSICIAN 59 

relations, in the upper-world it is accompanied 
by a secrecy of method and sequestration of 
administration that characterizes no other form 
of vice. 

The difference between the psychology of the 
doctor's relation to the drug habit and that of 
the- layman to it may be summed up in the state- 
ment that while the layman does not at all know 
what he is getting, the doctor knows what he is 
taking, but thinks that he can stop taking it 
whenever he feels ready. It is probable, there- 
fore, that the doctor's primary danger is as 
great as the layman's, and it is certainly true 
that his secondary danger — that growing out of 
the fact that he has drugs and the instrument 
for their administration always ready to his 
hand — is very much greater. 

The unnecessary administration of habit- 
forming drugs to the sick must be legally pre- 
vented as far as possible. No affliction which 
can be added to an already existing physical 
trouble can compare in horror with that of a 
drug habit. Numbers of cases have come un- 
der my observation in which physicians have 
accomplished exactly this addition to the ruin 
of their patients ' health, to the incalculable dis- 



60 HABITS THAT HANDICAP 

tress of the sufferers' families, and to the vast 
loss of society. In the recent legislation writ- 
ten upon the statute-books of New York State 
the first definite effort is made to provide 
against this catastrophe. 



CHAPTER IV 

PSYCHOLOGY AND DRUGS 

DRUG- habits may be classified in three 
groups : the first and largest is created by 
the doctor, the second is created by the drug- 
gist and the manufacturer of proprietary and 
patent medicines, and the third, and smallest, 
is due to the tendency of certain persons toward 
dissipation. 

The major importance of the first two groups 
is due to the fact that they include by far the 
greater number of cases, and to the pitiful fact 
that such victims are always innocent. Speak- 
ing generally, and happily omitting New York 
State from our statement, it is safe to say that 
the manufacturer, the druggist, and the physi- 
cian are without legal restraint despite their 
importance as promoters of drug habits, while 
the comparatively unimportant drug-purveyor 
in the under-world is held more or less strictly 
in control by the police, and is subject to severe 

61 



62 HABITS THAT HANDICAP 

punishment by the courts in case of a convic- 
tion. 

With few exceptions, the part which the doc- 
tor plays in the creation of drug habits is due 
to lack of knowledge; but the druggist's part in 
the spread of this national curse is purely com- 
mercial, and may justly be designated as pre- 
meditated. He always has gone and always 
will go as far as is permissible toward creating 
markets for any of the wares that he sells. 

Eegulation of the upper-world in regard to 
the distribution of habit-forming drugs will 
automatically regulate the under-world in its 
similar activities. The amount which will be 
smuggled by those of criminal tendencies al- 
ways will be small as compared with the amount 
improperly distributed through channels now 
recognized as legitimate until all the States 
have passed restrictive legislation founded 
upon, modeled after, and cooperative with New 
York State's legislation; and all this must be 
backed and buttressed by Federal legislation of 
a special kind before real and general good can 
be accomplished in the United States. Illicit 
drugs rarely find their way into the possession 
of users who have acquired drug habits through 
illness or pain. So it must be admitted that 



PSYCHOLOGY AND DRUGS 63 

most of the effort that in the past has been made 
toward restrictive legislation has really been de- 
voted to the interests of the nnworthy rather 
than to those of the worthy. Save in New 
York State, the man or woman with a sheep- 
skin — the doctor, the druggist, or the nurse — 
remains virtually a free-lance, permitted to 
create the drug habit in others or in himself 
or herself at will. 

THE DOCTOR A MEANS OF SPREADING THE DRUG 

HABIT 

The man in severe pain is immediately ex- 
posed, by the very reason of his misfortune, to 
the physician with a hypodermic or the druggist 
with a headache powder; the man who cannot 
sleep may at any moment be made a victim by 
the physician whom in confidence he consults, or 
by the druggist to whom he may foolishly apply 
for "something" which will help him to secure 
the necessary rest. Save in New York State, 
the druggist's shelves are crowded with jars and 
bottles holding dangerous compounds which he 
may dispense at will, his drawers are crowded 
with neat pasteboard boxes containing powders 
which are potent of great peril. The public will 
have made a long step toward real safety when 



64 HABITS THAT HANDICAP 

it realizes that any drug which brings immediate 
relief from pain or which will artificially pro- 
duce sleep is an exceedingly dangerous thing. 

The sick man 's confidence in his doctor is one 
of the doctor's greatest assets; it has saved in- 
numerable lives. It is of the same general na- 
ture as the mysterious mental phenomena which 
frequently control physical conditions, and 
which have been capitalized by various bodies, 
such as Faith Cure and Christian Science; but 
if this is an asset to the physician, the general 
public knowledge that he carries in his case or 
in his pocket drugs which he can use without 
restraint of law for the relief of pain may be- 
come a general peril. In the old days when the 
doctor's work was a mysterious process, operat- 
ing by methods of which he alone was cognizant, 
this peril was less well defined; but now that 
the spread of education has made everybody a 
reader and periodical literature of the times has 
given even children a smattering of knowledge 
concerning medical matters, the nature of the 
means by which the doctor works his miracles is 
well known, and his unrestraint may become a 
public peril. 

Of one thousand patients who may consult the 



PSYCHOLOGY AND DKUGS 65 

average physician, nine hundred and ninety-nine 
know perfectly well that he can stop their pain if 
he desires to do so. Pain is unpleasant; natu- 
rally their demands that he use his power are 
insistent. If he refuses, they are likely to call 
in another and less scrupulous physician. The 
medical profession is overcrowded, and perhaps 
the doctor needs the money. Even if he is 
swayed by nothing but financial need, he is likely 
to be tempted into the administration of pain- 
deadening substances when his patient urges 
him. 

There is another powerful influence which 
works upon the most admirable of men — the pity 
of the temperamental physician for the human 
sufferer. Most men who choose the medical 
profession as the avenue for their life-work have 
the qualities of mercy, pity, and sympathy 
notably developed in their psychology. This is 
likely to induce them to stretch points in favor 
of relieving suffering patients. Even when 
their previous experience has proved to them the 
danger lying in narcotics, they are likely to for- 
get it, or to r take a chance if a special emergency 
arises. This may be done without great peril 
to the patient. 



66 HABITS THAT HANDICAP 

DAXGEE OF THE KNOWLEDGE OE PAI^T-EEUEVIXG 

DRUGS 

The physician should exhaust every means 
known to medical science to prevent his patient 
from knowing what it is that eases pain when 
his practice makes it absolutely necessary that 
a substance of the sort should be administered, 
and this is very much less frequent than the 
average doctor realizes, as will be shown in 
another passage of this book. It is in this neces- 
sity for concealment that the great danger of 
using the hypodermic syringe as an adminis- 
trating instrument principally lies. The mo- 
ment the hypodermic syringe is taken from the 
doctor's or the nurse's kit, the sufferer is made 
aware of the means which will be used to give 
hi m ease. He remembers it, forming a respect 
and admiration, almost an affection, for the 
mere instrument, and with the most intense in- 
terest gathers such information as he may find 
it possible to acquire about this wonder-working 
little tool and the material which is its ammu- 
nition of relief. He knows absolutely that the 
relief which he has found is not due to medical 
skill, but to the potency of a special drug admin- 
istered in a special way. He stops guessing as 



PSYCHOLOGY AND DEUGS 67 

to whether he has been soothed by an opiate ; he 
knows he has been. 

It is not only those of weak psychology or 
mental characteristics who are affected by this 
knowledge and who through it become drug- 
takers, though it is the general impression that 
this is the case. No impression was ever more 
inaccurate. The mentally strong and the mor- 
ally lofty are as much averse to suffering physi- 
cal pain as the mentally weak and the morally 
degenerate. All are in the same class when the 
drug has been administered until that point of 
tolerance is reached where its administration 
cannot be neglected without the indignant pro- 
test of the physical body. That this fact should 
be impressed upon the medical profession as 
a whole is one of the most needful things I 
know. 

Another hazard which the doctor runs, if he 
passes the point of extreme caution in the ad- 
ministration of drugs to patients, is the possibil- 
ity, even the probability, that through such an 
administration he will lose control of his 
patients. From the moment the patient be- 
comes cognizant of the means which the doctor 
has successfully used to alleviate his pain, he 
begins to dictate to the doctor rather than to 



68 HABITS THAT HANDICAP 

accept dictation from him. No doctor can con- 
trol a case successfully unless his judgment is 
accepted as the supreme law of treatment. A 
patient who is not susceptible to the doctor's 
dictation cannot be expected to get the full ad- 
vantage of the doctor's skill or knowledge. If 
diagnosis shows that a patient requires some 
operation, as in certain uterine troubles, or 
more especially in the case of bladder affections 
or gall-stones, — cases in which frequently only 
an operation can give relief, — and if that patient 
is aware that even if the operation is not per- 
formed, the doctor can still ease all suffering, 
that patient, loath to run the risk of the sur- 
geon's knife, horrified by the thought of hospi- 
tals and operating theaters, is likely to demand 
the relief which opiates offer, and refuse to risk 
the cure which surgical procedure alone would 
certainly afford. 

The conscientious doctor who insists upon the 
proper course in such a case is seriously handi- 
capped by the presence in the medical profession 
of many men who are less conscientious, and 
who may yield more readily to the urgings of 
the patient. Thus the possibility of unre- 
stricted use of habit-forming drugs by the med- 
ical profession becomes a handicap to the con> 



PSYCHOLOGY AND DRUGS 69 

scientious man and a commercial advantage to 
the unscrupulous practitioner. 

UNCONSCIOUS VICTIMS OF THE DRUG HABIT 

Episodes occurring continually in the course 
of my work add to the strength of my conviction 
of the physician's responsibility. For years not 
a week has passed which has not brought me 
patients with stories of the manner in which 
they have become victims of drug addiction 
through the treatment of their physicians. Ly- 
ing before me as I write is a communication 
from a young man in Pennsylvania. He had 
been hurt, and through improper surgical atten- 
tion a healing fracture had been left intensely 
painful. The attending doctor, unable to cor- 
rect his imperfect work, had left with him a box 
of tablets to be taken when the pain became 
severe. Promptly and inevitably the youth 
achieved the drug habit. He felt disgraced, he 
would not tell his father, his wife, or his sister. 
His doctor could give him no relief. By some 
accident he saw an article of mine which was 
published in the " Century Magazine," and 
made a pitiful appeal to me. I have received 
many such communications. 

A pathetic letter comes to me from a woman 



70 HABITS THAT HANDICAP 

suffering with fistula. Having achieved the 
morphine habit as the direct and inevitable re- 
sult of taking pain-killing drugs given to her by 
her family physician, she now feels herself dis- 
graced. Like many sensitive women who in this 
or some other way become victims of the drug 
habit, she is obsessed, as her letter clearly shows, 
with the conviction that her achievement of 
the habit has been a personal sin, and that her 
continued yielding to it puts her beyond the 
pale of righteousness. She writes that she 
finds herself incapable of going to her church 
for Sunday services or to prayer meetings 
because she feels ashamed when in the im- 
minent presence of her Maker. Another woman, 
evidently animated by a similar psychological 
phenomenon, writes that having acquired the 
drug habit, although blamelessly, since it was 
through the administration of narcotics by her 
doctor, she finds it a psychological impossibility 
to kneel at her bedside and offer that prayer to 
God which it had been her nightly practice to 
deliver. 

I could multiply such instances indefinitely. 
It is impossible to conceive any episodes more 
pitiful than the cases of this sort which 
have been detailed to me by drug victims, 



PSYCHOLOGY AND DRUGS 71 

doctor-made. That feeling of disgrace, that un- 
justified conviction of sin on the part of abso- 
lutely innocent women victims of the drug habit, 
is apparently among the most terrible of human- 
ity's psychological experiences. If I had the 
pen of a Zola and the imagination of a Maupas- 
sant, I might properly impress the medical world 
with a sense of its responsibility in this matter. 
Without it I fear that I may fail to do so ; but 
could I accomplish only this one thing, I should 
feel that my life had been of use to that human- 
ity which I desire above all things to serve. 

No work could be of more importance to the 
world of sufferers than one which would put the 
use of these potentially beneficent, but, alas! 
often injurious, drugs upon a respectable basis, 
so that the man who must be given the relief 
which they alone can offer may no more hesitate 
to tell his neighbor that he is taking morphine 
than he now will hesitate to tell his neighbor that 
he is taking blue mass pills or citrate of mag- 
nesia. 

RESPONSIBILITY OF THE TRAINED NURSE 

That the medical world should ever have been 
so lax in its realization of its proper responsi- 
bility as to allow trained nurses to carry 



72 HABITS THAT HANDICAP 

hypodermic syringes and to administer habit- 
forming drugs seems to me to be one of the most 
amazing things in the world. No physician 
who has had an extensive experience with drug 
addiction and who has any conscientious scru- 
ples whatsoever will fail to make sure before he 
leaves a nurse in charge of a patient that the 
attendant possesses no habit-forming drugs and 
is without any instrument with which they may 
be hypodermically administered. If such drugs 
are to be used, they should be kept in the phy- 
sician's possession until they are used, and 
should be administered by means of an instru- 
ment which he carries with him. When such 
drugs are left, the nurse should give an account- 
ing for every fraction of a grain. 

I have no desire to convey the impression that 
in my opinion all nurses are untrustworthy or 
unscrupulous, but it must be remembered of 
them, as it must be remembered of the doctor, 
that they are in the employ of the patient, that 
their income depends upon giving satisfaction 
to their employer, and that they are likely to 
make almost any kind of concession and resort 
to almost any practice in order to make comfort- 
able and profitable assignments last as long as 
possible. It is impossible not to admit the truth 



PSYCHOLOGY AND DRUGS 73 

of this statement, and it must be recognized that 
if it is true, a nurse is under too great a respon- 
sibility when she is in possession of a hypoder- 
mic kit, particularly if the patient knows that it 
is her kit, her hypodermic, her drug, and that 
she will not be called to account by the physician 
for- such drugs as she may administer. It must 
be rather disconcerting for a physician to reflect 
upon the fact that a nurse whom he has left in 
charge of a critical case, through greed or even 
through the general and admirable quality of 
mercy, is equipped for, and ignorantly may yield 
to the temptation of, resorting to a practice that 
may not only undo all the good his treatment has 
accomplished, but, in addition, may afflict the 
patient with suffering more terrible than any 
which disease could give. This element of 
mercy, soft-heartedness, and readiness to pity 
must specially be remembered in considering the 
relation of the trained nurse to the patient. If 
men are often induced to enter the medical pro- 
fession because of its presence in their soul, even 
more frequently are women led by it to become 
trained nurses. The sympathetic woman is even 
more likely to yield to the pleadings of suffering 
patients than is the sympathetic male doctor. 
It must also be remembered that, like the doc- 



74 HABITS THAT HANDICAP 

tor, the nurse is human, and neither iron-nerved 
nor iron-niuseled. She is frequently under ter- 
rific strain, which makes her tend toward the 
use of stimulants of any kind. That which she 
can administer to herself by means of the hypo- 
dermic is closest to her hand, is easiest to take, 
and is least likely to be discovered. Again, too, 
it must be remembered that the nurse is as sus- 
ceptible to pain as are the rest of us. Suffering, 
with the means of alleviation at her hand, and, 
like the doctor, ignorant of its true peril, what is 
more natural than that she herself should use 
the hypodermic for her own relief? Thus it 
comes about that probably a larger proportion 
of trained nurses than of doctors are habitual 
drug-users. This is not a statement which is 
critical of the profession, for if all mankind 
knew of drugs, had hypodermics, and knew how 
to use them, a very large proportion of the 
human race would resort to this quick and 
effective, if inevitably perilous, means of finding 
comfort when agony assailed them. 

The world does not, the world cannot, under- 
stand that while to the normal human being the 
worst that can come is pain, the worst pain is 
vastly less terrible than the horrors which at 
intervals inevitably afflict the habitual drug- 



PSYCHOLOGY AND DKUGS 75 

user. Not one human being who has become a 
victim of a drug habit through its use for the 
alleviation of pain but will voluntarily cry after 
he has come to realization of the new affliction 
which possesses him, "save me from this drug 
habit, and I will cheerfully endure the pain 
which will ensue.' ' The horror of pain is not 
so great as the horror of the drug habit. 

Another very serious reason for extreme 
caution on the part of the medical profession in 
regard to the use of habit-forming drugs is that 
the effect of such drugs upon a patient must 
almost certainly make accurate diagnosis of his 
case difficult or even impossible. A patient 
whose consciousness of pain is dulled or elim- 
inated by the use of drugs cannot accurately 
describe to a physician the most important 
symptoms of his ailment. Without the assist- 
ance of such a description the physician is so 
handicapped that all the skill which he has 
acquired in practice and all the knowledge he 
has gained from study are apt to be of no avail. 
Indeed, in the case of habitual drug-users accu- 
rate diagnosis of any physical ailment is impos- 
sible until the effect of the drug has been so com- 
pletely eliminated that not one vestige of it re- 
mains. 



CHAPTER V 

ALCOHOLICS 

1AM not specially familiar with the statistics 
of insanity, but I am inclined to believe 
that an appreciable contribution to the total — 
indeed, one of its largest parts — has arisen from 
the improper diagnosis of drug and alcoholic 
cases, followed naturally by improper medical 
treatment. Lack of definite medical help in 
cases of chronic alcoholism is likely to bring 
about brain lesions, which eventually mean 
hopeless insanity. 

For that special reason, the chronic alcoholic 
has been the chief contributor to the army of 
the insane, and in the asylums his presence is 
notably frequent among the violent cases. The 
head of one of the greatest institutions in the 
United States for the care of the insane assures 
me that this seems to occur among women to a 
greater degree than with men. 

One of the most difficult problems of my work 

has been to discover ways by which the medical 

76 



ALCOHOLICS 77 

profession can be made to understand the really 
serious meaning of chronic alcoholism. Most 
delirium, the primary cause of which lies in al- 
coholism, is amenable to treatment. 

EFFECTS OF DEPRIVATION IN CHRONIC ALCOHOLISM 

It is exhaustion or lack of alcohol which first 
produces delirium in an alcoholic case, whether 
that exhaustion is due to the patients inability 
to assimilate food or alcohol or whether it is due 
to the fact that, being under restraint, alcohol is 
denied him. 

In most cases there is no form of medication 
which can be successfully substituted for alco- 
hol, and unless definite medical help is provided 
for the purpose of bringing about a physical 
change and thus avoiding delirium, no course 
remains safe except a long and very gradual 
process of reduction of alcoholic poisoning. 
Such a measure as this cannot be successfully 
applied in the wards of the general hospital, as 
the mere fact that alcohol was there adminis- 
tered, even in slowly diminishing doses, would 
make such a ward the chosen haven of innumer- 
able "old stagers," who, having reached that 
stage of worthlessness which would make it im- 
possible for them to obtain the narcotic else- 



78 HABITS THAT HANDICAP 

where, would take the treatment for the mere 
sake of getting the alcohol of which it princi- 
pally consists. 

Many friends of alcoholic subjects and many 
physicians in private practice have believed that 
they were doing the alcoholic a great service 
when they put him where he could not get alco- 
hol, and helped him over the first acute stages 
of the period of deprivation by the administra- 
tion of bromide and other sedatives. This 
usually means delirium first and then a "wet 
brain"; if the patient survives this, his next 
development is more than likely to be prolonged 
psychosis, or, in the end, permanent insanity. 
It is because of this that I consider the chronic 
alcoholic more clearly entitled to prompt and 
intelligent medical treatment than most other 
sick persons. With the alcoholic, as with the 
drug-taker, the first thing to be accomplished is 
the unpoisoning of the body. In order to ac- 
complish this, it is first necessary to keep up the 
alcoholic medication, with ample sedatives, using 
great care lest the patient drift into that ex- 
treme nervous condition which leads to de- 
lirium. If delirium does occur, nothing but 
sleep can bring about an improvement in the 
patient's condition. This is the point of de- 



ALCOHOLICS 79 

velopment at which physicians not properly 
informed in regard to snch cases are likely to 
employ large quantities of hypnotics, and fre- 
quently this course is followed until the patient 
is finally "knocked out." In many instances 
an accumulation of hypnotics in the systems of 
persons thus under treatment has proved fatal. 
I am rather proud of my ability to state that 
from delirium tremens I have never lost a single 
case. 

NECESSITY OF CLASSIFICATION OF ALCOHOLICS 

The records show that to-day about forty per 
cent, of the insane in the asylums of New York 
State have a definite alcoholic history. In this 
condition lies one of the greatest opportunities 
ever offered to the medical profession. Even 
now a proper classification of the patients thus 
immured, and their appropriate treatment, 
would in many instances result in the return to 
the normal of those affected; proper classifica- 
tion and treatment at the time when the symp- 
toms of mental disorder first appeared would 
have resulted in the salvation of innumerable 
cases. As a matter of fact, I earnestly believe 
that if this course was followed, the number of 
supposedly permanent cases of insanity arising 



80 HABITS THAT HANDICAP 

from alcoholic and drug addictions might be de- 
creased by seventy-five per cent. 

Certain general rules may be laid down. 
There are no circumstances in which it is advis- 
able for a physician in private practice to at- 
tempt to handle a case of chronic alcoholism in 
the patient's own environment. Efforts to do 
this are constantly made, with the result that 
many needlessly die from lack of alcohol, while 
an even more tragic result is the unnecessary 
entrance, first into the psychopathic wards of 
our hospitals and thence into our asylums for 
the insane, of innumerable cases which needed 
intelligent treatment only for alcoholism or 
drug addiction. If this treatment is neglected, 
the incarceration of these unfortunates in asy- 
lums becomes necessary, for without question 
their insanity is real enough. 

UNSCIENTIFIC METHODS IN THE TREATMENT OF 
ALCOHOLISM 

During the summer of 1913 I visited a large 
hospital in Edinburgh and discussed alcoholism 
and its treatment with the visiting physician. 

"We do not have many alcoholics here," said 
he. 

"Why?" I inquired. 



ALCOHOLICS 81 

"All our hospital work is supported by pri- 
vate subscription," he answered. 

1 i Then there is no place whatever in Scotland 
for the care of the acute alcoholic case?" 

"No. If an intoxicated person is locked up 
by the police and develops delirium, he is sent 
here, and we do what we can for him by the old 
methods. ' ' 

"You offer no definite medical help along 
special lines V 9 

' ' No ; we have none to offer. ' ' 

He showed me two cases in the general ward ; 
one man in a strait- jacket was in the midst of 
delirium tremens, his face terribly suffused. 
He was in a pitiable state, and nothing was 
being done for him. 

"What course shall we follow V 9 the physi- 
cian inquired. 

"Let me see his chart/ ' I requested. After 
I examined it, it became immediately apparent 
that the patient's condition was due to lack of 
his usual drug. It was his third day in the 
ward. 

"Nothing but sleep will save him," I said, 
and suggested medication which was adminis- 
tered. 

In three or four minutes the patient was re- 



82 HABITS THAT HANDICAP 

laxed and taken out of the strait- jacket. I 
made certain suggestions regarding general 
stimulation for the bowels and the kidneys, and 
diet. On the next day I found the patient im- 
proved after twelve or fifteen hours of sleep, 
and wholly free from delirium. His case had 
now become simply a matter of recuperation. 

Another case had lived through several days 
of delirium tremens, which had been followed 
by a "wet brain"; the visiting physician con- 
sidered this patient a fit subject for the psycho- 
pathic ward. I asked the patient questions 
about himself. He was sure that he had been 
out the night before and pointed out one of the 
internes as his companion during the hours of 
dissipation. His case was regarded at the hos- 
pital as almost certain to end in an asylum. I 
suggested treatment and within two days the 
man's mind had entirely cleared up. 

These instances of successful and prompt 
relief occasioned considerable surprise among 
the hospital physicians, who frankly admitted 
that they knew nothing to do except to keep the 
patients there under restraint, and, if necessary, 
feed them according to existing rules, to keep 
their bowels open and their bladders free, and 
hope for the best. 



ALCOHOLICS 83 

This was an institution which is supposed to 
represent the best medical learning in the 
United Kingdom. I found similar conditions 
existing in the great hospitals of London, Paris, 
and Berlin, so that the Scotch institution is not 
an exception to the general European rule. 
Everywhere I was frankly informed that the 
medical staff knew of nothing to be done in alco- 
holic cases beyond deprivation and penalization. 

Nor have we been more scientifically progres- 
sive in the United States. We are following 
virtually the same unenlightened methods, and 
it has even been suggested that chronic alcohol- 
ism be added to the conditions which in the 
minds of some sociological thinkers justify 
sterilization. How important our shortcoming 
is may be strikingly illustrated by the statement 
that alcoholic patients comprise one third of all 
the cases admitted to Bellevue Hospital in New 
York. 

THE DIFFICULTY OF TKEATMENT IN SOME 
ALCOHOLIC CASES 

The alcoholic differs notably from the person 
addicted to drugs. A drug-taker, deprived of 
his drug, will experience in the early stages only 
acute discomfort and a natural longing for the 



S4 HABITS THAT HANDICAP 

drag of which he has been deprived. Hi? un- 
favorable symptoms can always be relieved by 
the administration of the drug. The chronic 
alcoholic, however, deprived of the stimulant, 
often drifts into a delirium which cannot be re- 
lieved by the administration of his accustomed 
tipple. Xo more terrible spectacle can be imag- 
ined by the human mind than that of an acute 
case of delirium tremens ; no patient needs 
more careful watching in order that unfavor- 
able developments may be avoided: once de- 
lirium sets in. no type of case is medically so 
difficult to handle. The z21a.11 who for long 
periods has been saturated with alcohol, and 
who is suddenly deprived of it, is. I think, more 
to be pitied than almost any one I know: yet 
relatives, friends, and physicians frequently fol- 
low exactly this course, and think that by so 
doing they are rendering the patient a kindly 
service. 

CAUSES OF IXSAXITT 

In mentioning the causes of insanity, it is, 
however, impossible to permit the impression 
to be recorded that alcohol is the only offender. 
My statement of the part which alcohol plays in 
supplying the population of our mad-houses has 



ALCOHOLICS 85 

never been denied; but it is also true that the 
use of headache powders and other prepara- 
tions commonly sold at our drug stores and as 
yet slightly or not at all restricted by law, and 
the use of coffee, tea, and tobacco in unre- 
stricted quantity, also contribute their quota to 
the insane. A letter from the superintendent of 
a certain state asylum tells me that he has seen 
many improvements, sometimes even amounting 
to cures, result from ten days of fasting. That 
fasting really was a process of unpoisoning. In 
such a case the symptoms of insanity may be at- 
tributed to auto-intoxication, coming from any 
one of many causes, of which alcohol, tobacco, or 
even food improperly selected or unreasonably 
eaten may be one. The physician can have no 
means of learning just what method to pursue in 
any case of auto-intoxication until the patient 
has been unpoisoned. If any one of the great gen- 
eral hospitals would secure careful histories of 
one hundred of its patients and apply the proper 
methods to those who are found to have been 
poisoned by their habits, surprising results 
would be achieved. It is specially true that no 
intelligent mental diagnosis can be made of any 
patient who has had an unfavorable drug, alco- 
holic, or even tobacco, tea, or coffee history until 



86 HABITS THAT HANDICAP 

he has been freed from the effects of these drugs 
or stimulants. The first thing that a physician 
must do when confronted by a case of alcoholic 
or drug addiction is to learn whether it is acute 
or chronic. If the case is chronic, the patient 
must not be suddenly deprived of his stimulants. 






CHAPTER VI 

HELP FOE THE HAKD DEINKEE 

THE people of the world in general, and 
especially the people of the United States, 
are asking more questions about the cost of alco- 
hol — not its cost in money, but its cost in men. 
These are questions which statistics cannot 
answer, which, indeed, can never be definitely 
answered; but we know enough to be assured 
that if answers could be given, they would be 
appalling. With increasing unanimity the 
thinkers of the whole world are saying that in 
alcohol is found the greatest of humanity's 
curses. It does no good whatever; it does in- 
calculable harm. A dozen substitutes may be 
found for it in every useful purpose which it 
serves in medicine, mechanics, and the arts ; its 
food value, of which much has recently been 
said, is not needed; and it has worked greater 
havoc in the aggregate than all the plagues. If 
not another drop of it should ever be distilled, 
the world would be the gainer, not the loser, 

87 



88 HABITS THAT HANDICAP 

through the circumstance. Yet the use of alco- 
hol as a beverage is continually increasing. 
The number of its victims sums up a growing 
total. Sentimentalists have failed to cope with 
it, and the law has failed to cope with it. In 
combating it, the world must now find some 
method more effective than any it has yet em- 
ployed. 

"When we consider excessive drinkers as a 
class, we find that a large number of alcoholics 
are born with tendencies which make alcohol 
their natural and almost inevitable recourse. 
As a rule they are naturally highly nervous, or, 
through some systemic defect, crave abnormally 
the excitation which alcohol confers. For these 
reasons, granting favorable opportunity and no 
great counterbalancing check, they are fore- 
doomed to drink to excess. Some are predis- 
posed to alcoholism by an unstable nervous 
organism bequeathed to them by intemperate 
parents or other ancestors; others are drinkers 
because they do not get enough to eat, or fail, 
for other reasons than poverty, to be sufficiently 
nourished; and others, possessing just the fa- 
vorable type of physique, become alcoholics 
through worry or grief. All these kinds of 
people are victims of a habit which, properly 



HELP FOE THE HAED DEINKEE 89 

speaking, they did not initiate, and of which, 
therefore, censure must be very largely tem- 
pered. Yet they are generally treated as 
though they had perversely brought about their 
own disease, a course not more reasonable than 
the punishment of people for developing neph- 
ritis or cancer. 

The demand for a more effective as well as a 
more logical treatment of alcoholism has even 
greater urgency than comes out of this injustice. 
Much of our best material falls victim to this 
disease. By general admission the alcoholic 
often possesses many qualities of mind and tem- 
perament which the world admires and pro- 
nounces of the utmost value when rightly devel- 
oped. Even the careless weakling who drinks 
to excess is proverbially likely to be generous, 
magnanimous, warmly impulsive, even quixotic. 
The finest sensibilities, the most delicate percep- 
tions, and the most enthusiastic temperaments 
— from all of which qualities great constructive 
results may be expected — are notably the most 
exposed to alcoholism. A far greater number 
of its victims than the offhand moralist is in- 
clined to concede have admirable sturdiness of 
will and dogged persistence. With less, per- 
haps, they would not have become excessive 



90 HABITS THAT HANDICAP 

drinkers. They are alcoholics because with the 
help of stimulants they have habitually forced 
themselves to overwork, to bear burdens of re- 
sponsibility beyond their normal strength, or to 
overcome physical obstacles, like poor health, 
eye-strain, and insufficient nourishment. The 
man who drinks is not necessarily depraved; 
but under the influence of stimulant he is very 
likelv to drift into associations and environ- 
ments which will lower his standards until he 
becomes irresponsible, unaclmirable, or even 
criminal. 

AEE ALCOHOLICS GETTING A FAIR CHANCE? 

It is perhaps not going too far to say that 
most alcoholics have not been given a fair 
chance by their bodies, their temperaments, or 
the actual conditions of their lives. The ques- 
tion is, Are they getting a fair chance from so- 
ciety — society whose experience has demon- 
strated that it must in some way protect itself 
from them? 

At present the only public recognition of the 
alcoholic is manifested through some form of 
penalization. He loses his employment, he is 
excluded from respectable society, in extreme 
cases he is taken into court and subjected to 



HELP FOR THE HARD DRINKER 91 

reprimand, fine, or imprisonment. Nothing is 
done to bring about his reform except as the 
moral weight of the non-remedial punishment 
may arouse him to his peril and set his own will 
at work. Instances where this occurs are rare, 
because the crisis always comes when, through 
the. influence which alcohol has wrought upon 
him, his brain has been befogged and his will 
weakened. Society does virtually nothing to 
awaken that will or to assist its operation. The 
man whose drinking has so disarranged him 
physically or mentally that he is obviously ill is, 
it is true, taken to the alcoholic ward of some 
hospital, but even there no effort is made to 
treat the definite disease of alcoholism. For 
example, Bellevue and Kings County hospitals, 
where New York's two " alcoholic wards" exist, 
are institutions devoted specially to the treat- 
ment of emergency cases. As a matter of 
course, the alcoholics taken to them are merely 
"sobered up." As soon as they are sobered 
and have achieved sufficient steadiness of nerve 
to make their discharge possible, they are 
turned out again into the liquor-ridden city, 
with their craving for the alcohol which has just 
mastered them no weaker, with their resolution 
to resist its urging no whit stronger, than they 



92 HABITS THAT HANDICAP 

were before the crisis in their alcoholic history 
engulfed them. There is as yet no public in- 
stitution in New York City where a man, either 
as a paying or as a charity patient, may go for 
medical treatment designed to alleviate the 
craving for liquor; no organized charity makes 
provision for the medical treatment of the alco- 
holic. Only three States in the Union attempt 
to provide more competently than New York 
State does for this class of unfortunates. The 
provision they make progressively treats men 
convicted of drunkenness in the courts with sur- 
veillance, threat, colonization, and finally per- 
petual exclusion from society. Massaehnse::. 
has a colony for inebriates, New York is devel- 
oping one, and Iowa has had one for several 
years. 

This, then, is at present the treatment ac- 
corded by the public to the victims of this seri- 
ous disease. There are no clinics devoted to 
the study of alcoholism, although it is the ail- 
ment of probably one third of the sick people 
in the world to-day. Those who feel disposed 
to question this statement will be convinced that 
it is reasonable if they but make a count of the 
private sanatoriums dealing exclusively with 
alcoholics in and near New York, and, indeed, 



HELP FOE THE HARD DRINKER 93 

dotting and surrounding all our large cities. 
Connecticut, New Jersey, and Illinois will show 
a startling number. And it must also be re- 
membered that many of the cases of disease 
other than inebriety treated in all public hos- 
pitals have histories more or less alcoholic, and 
that the insane asylums are crowded with those 
gone mad through drink. It is the demand of 
common sense, not of sentiment alone, that this 
situation should be altered. 

Provision never has been made really to help 
even the man who, having lost control, is anx- 
ious to regain it. Inquire of the United Chari- 
ties in New York and of similar organizations 
in other cities, and you will learn that they are 
doing most intelligent work in the treatment of 
tuberculosis, but that alcoholism is getting only 
condemnation and punishment, not curative 
methods ; yet there probably are forty alcoholics 
to every consumptive. Neglect is almost uni- 
versal, and where that charge cannot be 
brought, there the errors are incredible and 
continual. Many are charitable toward the 
drunkard, giving him their dimes when he begs 
for them, and thus promoting his inebriety ; but 
society as a whole ignores him until he forces 
its attention through his helplessness or often 



94 HABITS THAT HANDICAP 

through some sin, which might be more rightly 
charged to alcohol rather than to any natural 
criminal tendency in the man's nature. 

ALCOHOLICS SHOULD BE TKEATED AS INVALIDS 

The physician, as things are, can do little with 
the sufferer from any ailment if his system at 
the time is impregnated with alcohol, for the 
alcohol may very likely prove an antidote to the 
medicines, or, if it does not, may prevent the 
patient from taking them. An alcoholic does 
not keep engagements ; he cannot be expected to 
take doses as prescribed by his physician. An 
alcoholic who is also ill of something else is 
doubly ill, but he usually gets treatment only 
for his secondary illness. No man who has lost 
control through stimulants is well, and until he 
has been definitely treated, he cannot be ex- 
pected to act normally. The world does not yet 
know how to deal with him. Sequestration as 
it is usually practised — trips round Cape Horn, 
weeks spent in the woods where liquor cannot 
be obtained — will never do it. Not only must 
the physical yearning be eliminated, but the 
mental willingness to drink must be destroyed 
before reform can be accomplished. It is at 
this point that the sentimentalists are wont to 



HELP FOR THE HARD DRINKER 95 

fail. A promise made by one in whom the crav- 
ing for the stimulant exists cannot properly be 
considered binding, for such a one is not re- 
sponsible for what he promises. If body proves 
stronger than the mind in such a battle, he is 
merely an unfortunate, not really a liar or a 
weakling. The world's loss through alcohol 
has been incalculable. No community ever ex- 
isted which could afford to relinquish the serv- 
ices of all its citizens who drink to excess or 
even of those who frequently get drunk. Yet 
society has continually maintained that when 
encountering the alcoholic it has crime, not dis- 
ease, to deal with. Hence the crudely ineffec- 
tive idea of penalization as a preventive. 

In general the nearest approach which has 
been made toward physiological treatment — 
beyond, of course, the mere "sobering up" in 
an occasional hospital of patients made deliri- 
ous by drink — has not been through medicine, 
but regimen, and this regimen has invariably 
included sudden enforced abstinence. This 
remedy is worse than the disease. It rarely 
helps and sometimes kills. I have seen many 
men who had been pronounced insane after 
they had been deprived of alcoholic beverages, 
without proper treatment, but whose minds be- 



96 HABITS THAT HANDICAP 

came perfectly clear as the result of the definite 
medical care their cases really required. Num- 
bers of far from hopeless alcoholics are yearly 
being sent to our insane asylums, where there is 
little chance of their recovery, I think. Fur- 
thermore, by merely depriving an alcoholic of 
alcohol without eliminating his desire for it, we 
are likely to force him into something worse. 
Thus the attempt to enforce abstinence upon the 
man who wants to drink is not only ineffective, 
but destructive. In making this statement I do 
not wish to be understood as being opposed to 
the prohibition of the sale of alcoholic bever- 
ages ; indeed, I should favor the most drastic re- 
strictions prohibiting the sale of alcohol. If 
there was never another ounce of alcohol manu- 
factured, the world would be none the loser 
either medicinally or commercially. My reason 
for making this statement is that prohibition of 
the sale of alcoholic beverages has been largely 
defeated because there have not been the proper 
safeguards thrown about the manufacture and 
sale of drug-store concoctions that can be had 
in any quantity as substitutes for alcoholic 
stimulants ; and I think the most drastic legisla- 
tion that could possibly be created on this sub- 
ject should be enacted and enforced against the 



HELP FOR THE HARD DRINKER 97 

druggists selling over their counters such con- 
coctions. 

The late Dr. Ashbel P. Grinnell, for seventeen 
years dean of the Vermont Medical College, 
studied this phase of the subject, gathering in- 
teresting statistics. 

After Vermont's adoption of prohibitory leg- 
islation, he sent out to wholesale and retail drug 
stores, general stores, and groceries that car- 
ried drugs as a part of their stock a letter in 
which were inclosed blanks calling for specific 
information concerning the sale of habit-form- 
ing drugs. Such was his personal standing in 
the State that he received responses from all 
but two or three of those whom he addressed, 
and these indicated that such sales had swelled 
rapidly until they indicated a daily consump- 
tion equal to one and one half grains of opium 
or its alkaloids for every man, woman, and child 
in the State. This vast increase in the use of 
dangerous drugs he attributed solely to the pro- 
hibition of the sale of liquor. Thus it must be 
argued that the attempt to enforce abstinence 
upon the man who wants to drink is not only in- 
effective, but destructive. Society may thus 
save itself from a few drunkards, but is likely to 
get lunatics or "drug-fiends" in their places. 



98 HABITS THAT HANDICAP 

REFORM CANNOT BE ATTAINED BY PUNISHMENT 

At the foundation of the present treatment of 
the alcoholic is usually the idea that threaten- 
ing with punishment can be effective. Actual 
experience and the slightest examination prove 
this to be preposterous. Many a man who 
drinks when he knows he should not, does so be- 
cause he cannot control himself, and he who has 
lost his self-control is obviously irresponsible. 
A threat, or the remembrance of a threat, can- 
not restrain him. A man who had committed a 
crime while drunk, but whose whole career had 
otherwise been reputable, was sentenced to life 
imprisonment. After he had served six years 
his friends presented so strong a case to the 
governor that he was pardoned, but with the 
warning that if he took one drink he might be 
returned to prison to complete his sentence. 
An excellent illustration of the slight influence 
of fear upon the alcoholic is furnished by the 
fact that within a very short time he was ar- 
rested for public drunkenness. Punishment 
breeds rebellion, and when you make a man re- 
bellious you are most unlikely to reform him. 
Punishment has never yet cured a disease. The 
inflamed brain not only carries grudges, but is 



HELP FOR THE HARD DRINKER 99 

almost sure to intensify them. If a man is dis- 
charged from his employment or arrested at a 
time when he is in the abnormal alcoholic state, 
the effect on him cannot be reformatory ; it must 
be to arouse his resentment, not his repentance. 
The employer who discharges a good man from 
his -position because of drunkenness not only 
fails to deal intelligently with the man or with 
the subject, but may very likely be committing a 
crime against society by robbing it of a useful 
citizen and at the same time forcing a useless 
one upon it. A man taken to court for drunk- 
enness should with great care be properly classi- 
fied. It should be determined whether he is an 
habitual drunkard, an occasional drunkard, or 
an accidental drunkard. There may be hope 
for the occasional drunkard, there is invariably 
hope for the accidental drunkard. If one of 
these is found to have employment at the time 
of his arrest, great care should be exercised not 
to let the fact that he has been arrested preju- 
dice his employer against him, and as far as 
possible he should be spared humiliation. 
Nothing will more quickly unfit a man for any- 
thing worth while than humiliation. To pun- 
ish such a man with a prison term will help no 
one. 



100 HABITS THAT HANDICAP 

Neither should he be sent back to his liberty 
without some recognition of the fact that he has 
been drunk and irresponsible. Any police offi- 
cer, and more especially any police-court re- 
porter, will testify that almost every man who, 
having been arrested for drunkenness, is dis- 
charged from custody without penalty, for one 
reason or another, social position, political im- 
portance, or previous good character record, 
will find a saloon within two blocks of the court 
and take a drink on the way home. He will 
probably not get drunk, — the impression made 
by his arrest will remain too strong to permit 
that, — but he will take a drink. And that and 
other drinks will help time drive from his mind 
the memory of the arrest, the cell, the court. 
And what is true of him who has been arrested 
and discharged is also true of him who has been 
arrested and imprisoned. Punishment fails ut- 
terly to "reform" the alcoholic. 

Nor is colonization more effective, except for 
the hopeless cases. It means segregation. A 
man once said to me: "I want to be helped, 
but not at the cost of compulsory association 
with others seeking help. I know that to be 
thrown into unavoidable contact with those 
worse than myself would hopelessly degrade me. 



HELP FOR THE HARD DRINKER 101 

I should not be willing to risk that, no matter 
how much good the treatment might do me." 
Colonization of the occasional alcoholic stamps 
him only a little less deeply than his stripes are 
sure to stamp the criminal who is sent to prison, 
and its effects upon him and his family are not 
more desirable than they would be if the process 
made exactly that of him. He is likely to be 
barred from employment after his discharge 
from the colony, and thus find it impossible 
to reestablish himself. Moreover, during the 
period of sequestration it is difficult to devise a 
plan for the care of the wives and children of 
those sent into seclusion. At a time when noth- 
ing in the way of betterment can be expected of 
him unless he regains confidence in himself, 
such treatment does not strengthen, but 
cripples, a man's spirit. Surveillance after his 
return will work on his imagination, cowing him 
into morbidness, until that alone will first 
weaken his will and then break it down. Too 
great emphasis, therefore, cannot be placed 
upon the viciousness of colonization for any but 
the first of the three classes into which I have 
said that all men charged in court with drunken- 
ness should be carefully separated. Coloniza- 
tion of the hopeless is advisable only because 



102 HABITS THAT HANDICAP 

such men. before they have descended to that 
stage, have cost their friends and societv all 
that it is advisable to spend on them. If the 
man who is worth while is to be saved, it 
mnst be without the application to hi m of the 
br*and. 

So much for the existing public methods of 
dealing with the alcoholic. The most usual 
private method is for a man's family or friends, 
when he has lost control, to send him to some 
place where he can ''get a grip on himself." 
But he often does not receive in such a place, 
any more than in the hospital or prison, that 
specialized treatment which can make that 
regained grip effective. General treatment, ac- 
sompanied by a gradual withdrawal of stimu- 
lant, will restore his t : lily strength, with the 
result, in nine cases out of ten. that when he 
emerges from the seclusion he is able to drink 
more than he was before he was sequestered, 
and will be sure to come to grief more quickly. 
In most cases his craving and need for stimu- 
lant are in no degree decreased, and in conse- 
quence he will frequently relapse while going to 
the railway station on the homeward journey. 
An even graver danger is that, while still in full 
possession of the alcoholic habit, he will in addi- 



HELP FOR THE HARD DRINKER 103 

tion contract the hypodermic habit, and any 
drug habit developed in the alcoholic is the most 
difficult of cases to deal with successfully. If 
he does relapse, his friends will almost surely 
hold him blameworthy and impatiently aban- 
don him as hopeless, believing everything 
to have been done which can be done. In 
reality nothing at all useful has been done to 
help him. He is a sick man, and no attack what- 
ever has been made on his disease. 

COMPLETE MENTAL. CHANGE MUST PEECEDE REFOKM 

This brings us to the kernel of the matter. 
No man who has become addicted to the use of 
alcohol can possibly abandon it unless he has 
first undergone a complete mental change, and 
in ninety-nine cases out of a hundred this altera- 
tion of the mental state will not come until he 
has experienced a physical revolution. The 
reason for this is simple. Excessive use of al- 
cohol really deteriorates body and brain tissue, 
and tissue degeneration transforms for the 
worse the entire physical and mental make-up 
of a man. The confirmed alcoholic is in the 
state which, save in rare instances, nothing 
short of specialized medical treatment can cor- 
rect. Mere general building up of bodily tone 



104 HABITS THAT HANDICAP 

is as ineffective with alcoholics as is enforced 
deprivation or punishment. 

I emphasize this point particularly because 
many men are afraid to take any treatment for 
alcoholism lest through it they lose their stand- 
ing with themselves or with their neighbors. 
Self-respect must be protected at every stage of 
the struggle as the patient's only hope. My 
purpose here is to show that the only chance of 
reforming most alcoholics lies in giving them 
opportunity through this physiological change 
to reestablish confidence in themselves. 

In setting about the business of treating an 
alcoholic, the first step is to realize that he is 
in an abnormal mental state. To moralize or 
to appeal in the name of sentiment to a warped 
and twisted mind is, I believe, sheer waste of 
time. To the man who has lost control, it must 
be first restored before he can be put to think- 
ing. You cannot expect the distorted alcoholic 
brain to be honest with vou or with itself. 

I cannot emphasize too strongly the harm that 
may come out of simply depriving the chronic 
alcoholic of his stimulant. I know that there 
are many relatives and friends and even physi- 
cians who, out of pure desperation, feel that 
they have accomplished much when they are able 



HELP FOR THE HARD DRINKER 105 

to put a man where he is unable to get his drink, 
irrespective of the amount which he has been 
accustomed to take. I consider the chronic al- 
coholic one of the most important cases in medi- 
cine to deal with successfully. Strange as it 
may seem to the layman, — and it is just as 
strange to the physician, — to such a case there 
is absolutely no other form of artificial stimu- 
lants that will take the place of alcohol, and 
when a patient is deprived of his accustomed 
stimulant, within twenty-four hours he begins 
to drift into delirium tremens, which means that 
the patient is a very sick man, and unless he is 
properly treated, will, if he lives through the 
active period of delirium, drift into a "wet 
brain,' ' or, in other words, alcoholic insanity; 
and even if the patient survives the latter ill- 
ness, a large percentage of such cases prove in 
the end to be hopelessly insane, and about eighty 
per cent, of the delirium tremens cases that do 
not get proper medical help die. It is a very 
serious matter dealing with the chronic alco- 
holic. Something definite must be done for 
such a case; deprivation is impossible; simple 
reduction is sometimes a failure ; nothing short 
of definite medical, hospital work will unpoison 
this sick man and avoid the complications of de- 



106 HABITS THAT HANDICAP 

lirium, "wet brain," or possible hopeless in- 
sanity. 

The second step is to give the patient that 
definite medical treatment which will correct 
his physical condition. Once this change has 
been effected, you have a man whose system is 
no longer crying out for liquor, with every 
nerve a-quiver for it, every tissue thirsting for 
it. There have been reforms from alcoholism 
which were not preceded by this physiological 
change, but they have been rare. 

The physiological metamorphosis may be ac- 
complished from without, by means of treat- 
ment, without assistance from the patient other 
than mere acquiescence. The mental change 
can be assisted from without; it cannot be ac- 
complished or maintained by any one except the 
patient. Despite himself a man may be success- 
fully treated for other ailments, but not for al- 
coholism. By an intelligent subsequent atti- 
tude friends or physicians may help to restore 
self-confidence, but that is all they can do. 

After the desire for it has once been elimi- 
nated, the patient cannot afford to take any 
alcohol whatever, and after a proper change 
of mental attitude he will not wish to. From 
alcohol he must abstain altogether, even in ill- 



HELP FOR THE HARD DRINKER 107 

ness. Let no recovered alcoholic risk relapse 
because alcohol seems to his physician to be de- 
sirable as a medicine. Indeed, the most ex- 
treme care should be exercised to avoid medi- 
cines containing alcohol even in small percent- 
ages, and this will bar most of the proprietary 
remedies. When he is hungry, let the recov- 
ered alcoholic eat ; when he is weary, let him be 
sure to rest; when he feels ill, let him be sure 
to consult without delay a competent physician. 
None of these conditions indicates a necessity 
for alcohol. 

Thus the man who is not hopeless may be 
saved. Society owes every alcoholic a fair op- 
portunity to reform ; it may be questioned if it 
owes him repeated opportunities. Many alco- 
holics never have been and probably never could 
be useful citizens. Waste of money and emo- 
tion on them is lamentable to contemplate; the 
sums at present thus hopelessly thrown away 
would aggregate enough really to restore every 
alcoholic actually curable. Sentimentalists do 
not like to admit the limitations of useful help, 
but those limitations do exist, and we should 
reckon with them. If we do, the man really 
curable will have all the better chance. 



108 HABITS THAT HANDICAP 

A TEST OF THE WORTHY 

It is possible to discriminate between the 
curable and the incurable by the simplest of ex- 
pedients. Usually the question, What is this 
man willing to do in return for help? will, with 
its answer, also supply the answer to the in- 
quiry as to his future. No man of sufficient 
mental fiber to make helping him of any actual 
value is willing to accept charity. Even if 
he finds himself at the moment unable to re- 
pay the debt involved, he will be anxious to 
make it a future obligation. My fifteen years 
of experience have proved to me that the sense 
of personal obligation is of great moment in 
this matter. Even when it becomes necessary 
for a relative, employer, or friend to assist a 
patient by the payment of his bills, it should 
be regarded a part of the treatment to consider 
this a loan, which must be repaid, and not a gift. 
It follows, sadly enough, that the most hopeless 
alcoholic is the rich young man to whom finan- 
cial obligations incurred for treatment mean 
nothing whatsoever, and to whom responsible 
employment is unknown. Indeed, it seems 
well-nigh impossible to reform the vagrant rich. 
The man who thinks that giving up his alcohol 



HELP FOR THE HARD DRINKER 109 

is primarily a privation, although he may ad- 
mit the definite necessity of this privation, is 
not likely to reform permanently; but there is 
hope for that one who declares without apology 
that drinking is a bad business and that he 
wishes to be helped to stop it. I cannot say 
with too great emphasis that self-respecting 
pride is the main hope of the alcoholic. 

It must not be overlooked, however, that it is 
the pride of the curable alcoholic which makes 
him difficult to reach. To try to help such a 
man when it is too late is a pitiably usual ex- 
perience, for not until it is too late does the 
pride of such a man allow him to apply for 
help. The man who says, "I will not drink to- 
day," and finds himself compelled to; who 
promises himself, but cannot keep his promise, 
is the man who most deserves help, and is most 
likely to yield some sort of good return on an 
investment made in him. Indeed, it is the rare 
alcoholic, curable or incurable, who of his 
own initiative submits himself to treatment. 
Friends must assist; but while the importance 
of such friendly service cannot be overesti- 
mated, it must be of the right kind or it will be 
worse than useless. Friends of alcoholics too 
often either sentimentalize or bully when they 



110 HABITS THAT HANDICAP 

go about the task of helping, or they allow too 
little time for the acconiplishinent of the reform. 
Successful business men are specially likely to 
act childishly when dealing with the mighty 
problem of assisting alcoholics to their feet. 
They are likely to affirm that there is no excuse 
for any man who yields to drink. If they have 
given help before, they are prone to call atten- 
tion to the fact that their beneficiary has not rec- 
ompensed their kindness by reforming, and de- 
clare, for instance, that they will pay his board 
another week, but that will be the end of their 
endeavor. This spirit — and it is the usual 
spirit — can accomplish nothing : and the money 
spent in this and other ill-considered and half- 
hearted efforts to save men has not decreased, 
but has increased, the dissipation it has sought 
to stop. Even relatives and intimate friends 
are likely to become weary of a case which ship- 
ment to some private institution, deportation to 
a ranch, or embarkation on a sailing-vessel for 
a long voyage has failed permanently to help. 

Such treatment works no reforms, or almost 
none. Until the cause of drinking is removed, 
travel from one place to another in an effort to 
obtain reform by breaking up old associations 



HELP FOR THE HARD DRINKER 111 

will be of no avail, but will, instead, repeat the 
experience of the old woman in the fairy-tale 
who was bothered by a goblin. When she up- 
rooted herself from her old home and sought 
another, the goblin, hidden in a churn, went with 
her. It was the old woman, not the cottage, he 
was haunting; it is the man, not his environ- 
ment, in which the alcoholic habit finds its 
stronghold. When a patient by intelligent 
treatment has been put into a receptive state of 
mind, he should be told to look up his old asso- 
ciates and to them declare himself upon the 
liquor question. If they are friends, they will 
congratulate him; if they are not, he will have 
gained by making certain of it. And there is 
very little danger that, after he has seen them, 
he will wish again to make intimates of them; 
that after, in his sober senses, he has examined 
the surroundings which they frequent, he will be 
willing to return to them. Being himself nor- 
mal, he will wish for normal men as friends ; be- 
ing far more fastidious than he was when he 
was alcoholic, the old haunts will fill him with 
disgust. This declaration of himself the man 
must himself make. Good friends may help 
him otherwise, and chiefly by refraining from 



112 HABITS THAT HANDICAP 

the slightest thing which may hy any chance 
tend to decrease his self-respect and his confi- 
dence in his own power to stay reclaimed. 
What a man needs is a new mind on the subject. 



CHAPTER VII 

CLASSIFICATION OF ALCOHOLICS 

ALCOHOLICS are more easily classified 
than drag-takers. With few exceptions, 
alcohol-users have their beginnings in social 
drinking. Not a few women and boys have had 
their first taste of alcohol, and may even have 
acquired a definite alcoholic habit, through the 
small quantities administered as stimulants by 
physicians; but in a general way it is as easy 
and just to absolve the physician from re- 
sponsibility in the matter of alcoholism as it is 
easy and just to put a heavy responsibility upon 
him in the case of the use of drugs. 

THE DEMAND FOR STIMULANTS 

In these days all mankind searches for ex- 
hilaration. The instinctive demand for it is an 
inevitable result of the artificial social system 
which we have built up. We work beyond our 
strength, and naturally feel the need of stimu- 
lants; we play beyond our strength, and as 

113 



114 HABITS THAT HANDICAP 

naturally need whips for our vitiated energies. 
The greatest social disaster of all the ages oc- 
curred when first alcoholic stimulation, which is 
only one step in advance of alcoholic intoxica- 
tion and narcotization, found its place as an ad- 
junct of good-fellowship. All humanity turns 
in one way or another to artificial stimulants, 
and while alcohol and narcotics are the worst 
among these, we cannot slur the fact that many 
who would shun these agents as they would a 
pestilence, turn freely to milder, but not alto- 
gether harmless, stimulants, such as tea, coffee, 
and tobacco. 

I do not purpose to go into a long dissertation 
upon the chemical peculiarities of alcohol; I do 
not purpose to discuss the value or peril of alco- 
hol as food ; there are plenty of published chap- 
ters telling exactly what alcohol is. I feel that 
it is my mission to do none of these things, but 
to endeavor to reveal to the student the most 
effective way of dealing with a patient who has 
drifted into a definite alcoholic addiction. 

THE MAN WHO CANNOT BE SAVED 

It seems impossible to arouse any enthusiasm 
or sympathy for the human derelict whose 
natural weakness is inevitably such that one 



CLASSIFICATION OF ALCOHOLICS 115 

taste of alcohol means a gallon, and final wreck 
and ruin. The human cipher, plus alcohol or 
minus alcohol, it matters not which, means 
nothing. It may be true that alcohol subtracted 
from nothing leaves nothing, but it is certain 
that alcohol added to nothing may mean a peril 
to -society and a serious charge upon it. 

A man who has achieved nothing up to the 
point where he has become addicted to excessive 
alcoholism will rarely repay the trouble in- 
volved in an effort to preserve him from his 
folly, although of course his preservation from 
it might be of general social service as a means 
of saving the public money that otherwise might 
be expended in the reparation of the work of his 
destructive tendencies, besides the public ex- 
pense involved in police, court, and prison econ- 
omy that prevents him from the opportunity of 
indulgence. But thousands of decent men an- 
nually yield to alcohol, and are wrecked by it. 
The decent and potentially valuable citizen who 
through overwork, worry, sickness, sorrow, or 
even through a mistaken conception of social 
amenities or duties, drifts into excessive alco- 
holism is a victim of our imperfect social sys- 
tem, and repays remedial effort. Furthermore, 
such a man is invariably savable if he himself 



Ill HABITS THAT HANDICAP 

applies : : r =.: -ion, assists with: Ins own will 
in its applio ; 1:1 : : his case, and pays his own 
money for the cure. 

The proportion of the eases that can be saved 
among ihe general run :: ilconolies who are 

iiziitIi - i: : si fr : is :r iiti stjziit".! - ":: : 5- 
ier:is irisnls to make them likely to come un- 
- r r 117 in - : : : ".: — :~ ; :i : n amonnts to about one 
iiinir :: 111 ~i:ls I - -rill :e : :t: _ t! 111: 
:~s : . ; :n : : r 1 1 : li : Ii 33 is far below the claim 
wiiidi I have m 1 le for drug-n sera 

~^~isri i: is icini :iii: : mss ■:: ri::issive al- 
:oi zlisii 115 zz : ~n : 1: : : : 1:1 : 1 1 normal 
5 1 = t : : 11 si : n si'jflity where excessive alcohol- 
isii 11 = n: :i-l :i_T 1 :int at which, deteriora- 
:i » : : 111 m : 1 I nature has set in, or whei r so- 
:iil ill miii ^i-:i.iiTi_^i- ; :ir Tidy have 
lesul te dy a problem is presented which is eom- 
11 1 r ~ t 1 ~ t : 7 1:1: : 11 _. _n 11 : 1 :■. : 1 ; 1 
r riian definite medical treatment must 
: - 1 l: ' t : : r 1 complete restoration of 
the unfortunate to social usefulness can be 
i : - 1 : : 1 lis ziatnrally irresponsible person 
: : 111 jers : 1 : 1: f : 17 i r 1 into irresponsibility 
:y ili:ii:iisii 1117 li rriiriil: is 1:1 ::ln:si 
iiieliss 17 IT-: sir.-::: Tills is y-:ii:;:' _ 111 
11s 1 — 1 t ; - 1 : 1111:1 : " 1: .1 "Ion can be im- 



CLASSIFICATION OF ALCOHOLICS 117 

posed upon the patient as a part of the treat- 
ment. The very poor for whose treatment 
some one else must pay, and the very rich to 
whom the sum paid for treatment is a matter of 
no moment, are almost equally hopeless. My 
long experience has taught me that the man who 
does not feel a financial responsibility for that 
which is done for him is usually the least prom- 
ising of all the cases brought to me, I have 
found it necessary to regard as a definite part 
of my treatment the imposition of a monetary 
obligation. 

If, for example, the employee of a person or a 
corporation is sent to me for relief from alco- 
holic tendencies by his employer or employers, 
I invariably refuse to accept the case unless it 
is agreed that the sum paid for the patient's 
treatment shall be held against him as an obli- 
gation to be repaid as soon as possible to those 
who have advanced it. Even the man who is 
curable will fail in a psychological realiza- 
tion of the misfortune into which he has actu- 
ally fallen through alcoholic indulgence unless 
he himself must pay the fiddler. In the case of 
a working-man who is brought to me for treat- 
ment by his employers, I make a minimum 
charge as a rule, but only on the condition that 



118 HABITS THAT HANDICAP 

with all due speed it is deducted from his pay- 
envelop. In the case of men of a higher order, 
as professional employees, heads of depart- 
ments, etc., I insist in a general way upon fol- 
lowing the same line of procedure. I cannot 
too strongly emphasize my absolute conviction 
that it is invariably a waste of money and time 
for an employer or an employing company to 
attempt to help alcoholics by means of free 
medical treatments. No good will come from 
this in the long run, as it never will prove to be 
worth while. Thus we may classify very rich, 
utterly poor, and irresponsible inebriates as 
among the hopeless. From every moral, social, 
and economic point of view the hopeless inebri- 
ate is a liability to the world at large. Throw 
him in the sieve of respectability, and soon or 
late he will always prove small enough to slip 
through the meshes. 

COLONIZATION OF ALCOHOLICS 

Among such cases will be found fit subjects 
for colonization, and these are the only ones 
who should be treated in this way. No greater 
social mistake is possible than the colonization 
and segregation, either in sanatoriums or inebri- 



CLASSIFICATION OF ALCOHOLICS 119 

ate farms, of other than utterly hopeless alco- 
holic cases. The next greatest mistake undoubt- 
edly is society's failure to segregate those who 
are utterly beyond the pale of hope. These men 
and women will be less of a burden to their 
friends and the community after segregation; 
their segregated existence will not constitute a 
threat against society of the present and future 
generations. It is my opinion that these 
people, men and women, rich and poor, should 
be sterilized and put at work. It is possible 
that this plan, if properly carried out, might 
develop some institutional effort worth while. 
That at present practised means a waste of 
time and money. 

It should be borne in mind that deprivation 
never yet removed the underlying cause of the 
desire for alcohol, no matter over how long a 
period this deprivation may have extended, nor 
has it ever removed the desire itself. These 
things can be brought about only by the elimi- 
nation of the poison from the victim's system. 

All alcoholics, no matter whether they are 
preferred risks or hopeless cases, whether they 
are to be returned to society or isolated and 
sterilized, should be unpoisoned. 



120 HABITS THAT HANDICAP 

SUCCESS OF THE SPECIFIC TREATMENT 

The first exhaustive test of this treatment for 
alcoholism was made at Bellevue Hospital, and 
its results were announced in a pamphlet pub- 
lished by Dr. Alexander Lambert. The hos- 
pital in which the work was carried on was 
without ideal facilities ; overcrowded wards and 
an insufficiency of nurses were among the many 
handicaps. That the results were more hope- 
ful than anything theretofore accomplished is 
indicated by the following extracts from 
articles by Dr. Lambert : 

RESULTS 

I am often asked as to the success of this treatment 
and the percentage of patients who remain free from 
their addiction. This varies enormously with the in- 
dividual patients and one can only judge from one's 
experience. My personal experience is that 11 per 
cent, of the morphinists and 12 per cent, of the alco- 
holists return for treatment. Doubling this percent- 
age it still gives us 75 per cent, as remaining free from 
addiction. Of these a very high percentage are 
known to have stayed free. 

SCOPE OF THE TREATMENT 

This treatment is not offered as a cure of morphin- 
ism or as a cure of delirium tremens or chronic alco- 



CLASSIFICATION OF ALCOHOLICS 121 

holism, as I said in the first article. It will, however, 
obliterate the terrible craving that these patients suf- 
fer when, unaided, they endeavor to get off their drugs 
or are made to go through the slow withdrawal with- 
out some medication to ease them. Compared with 
the old methods of either slow withdrawal or rapid 
withdrawal, it is infinitely superior. Deprivation of 
a drug is in no way equivalent to elimination of that 
drug from the body. Deprivation causes suffering; 
elimination relieves it. But neither this combination 
of drugs nor any other combination known to man can 
prevent persons, after they are free from their addic- 
tion — be it alcohol or morphin — from going out and 
repoisoning themselves by taking again the drug 
which has poisoned them and led them on to their 
habitual intoxication. 

There are many more morphinists who have uncon- 
sciously fallen under the spell of the habit through 
no fault of their own, than can be said of alcoholists. 

To any one who has ever tried to break off a patient 
by the old withdrawal methods when they were taking 
goodly amounts of the drug, and has struggled to 
keep them free from it after they have ceased taking 
it, the difference in the picture when undergoing the 
treatment by this new method is most striking. 

With this treatment most patients do not suffer 
more than a bearable amount of discomfort of hot 
flashes, slight pains, and the discomfort of their 
cathartics. When properly administered, this is the 
full extent of suffering with the majority of patients. 
Some do not go as far as this, a few suffer more. But 



122 HABITS THAT HANDICAP 

when improperly administered, they can suffer as 
much by this method as by any other. 

No test more exacting than the one made at 
Bellevue Hospital could be devised. Most of 
the cases appearing for treatment in the wards 
of that institution are of the most advanced type, 
for the nature of the New York hospital system 
may be said in a general way to select for Belle- 
vue the least hopeful patients coming from the 
least hopeful classes of society. If, therefore. 
anything approaching permanent relief was se- 
cured for as many as twenty out of every one 
hundred cases, an extraordinary efficiency was 
indicated. 

Of course the intelligent reader will under- 
stand that no man with reason can claim for 
any treatment the power permanently to di- 
vorce from alcohol a man who does not wish to 
be divorced from it. To take a man whose sys- 
tem has reached that degree of craving for alco- 
hol that he would sign away his right to salva- 
tion in exchange for a drink after a brief peri : : 
of deprivation, if he could not otherwise obtain 
the alcohol, and to unpoison him so that he 
feels no necessity or even the slightest desire 
for a drink or for any stimulant, is to ac- 



CLASSIFICATION OF ALCOHOLICS 123 

complish a great deal of good. It means that 
his nervous system has been restored to some- 
thing nearly normal, and that he has been given 
a chance. The man who has not had this help 
from outside can do nothing for himself; but 
having been cleared of alcoholic poison, he is 
brought into a mental state wherein he finds it 
possible to estimate reasonably the harm which 
alcohol has done him. The patient is then in a 
mental state that enables his relatives and 
friends to deal with him without being forced to 
estimate and allow for alcoholic abnormalities 
in his processes of thought. He is in a physical 
state that, although it apparently may be worse 
than that in which the alcohol had placed him, 
is nevertheless one that will enable his physi- 
cian to work with him intelligently. 

Such an achievement seems a perfect piece of 
medical work of its kind. Properly carried out, 
my treatment will accomplish exactly this in 
every instance. It will accomplish it within fi.~ve 
days and very likely within three days. I have 
never known it to require a period of more than 
seven. 

When this treatment is properly provided for 
throughout the country, it will be found that 



124 HABITS THAT HANDICAP 

neither large nor costly institutions will be nec- 
essary. The stay of every patient is so brief 
that in the average community a small institu- 
tion containing only a few beds will be found 
sufficiently large to meet all local needs. 

THE HABITUAL DRUNKARD IS NOT A CRIMINAL 

Legislation restrictive of the sale and use of 
habit-forming drugs is in reality a dangerous 
experiment until other legislation that provides 
for the medical help of those who would thus be 
deprived has first been written upon our statute- 
books. I am inclined to think that many of the 
failures which strew the paths of experimental- 
ists in anti-alcohol movements have been due 
to a lack of similar foresight. The man who is 
penalized for drunkenness will usually get 
drunk again the moment he finds himself at lib- 
erty to do so; and this will not be due to any 
natural depravity upon his part, but, rather, to 
an almost inevitable result of the bodily crav- 
ing that thrills his every fiber and for the relief 
of which nothing whatever has been provided. 
We shall never make any serious progress in 
dealing with the most serious evils of alcohol- 
ism until we waken to the folly of treating the 
hard and habitual drinker as a criminal, exact- 



CLASSIFICATION OF ALCOHOLICS 125 

ing from him penalties and inflicting upon him 
disgrace. 

In every instance the passage of restrictive 
legislation should be accompanied by the pass- 
age of remedial legislation; for provision for 
the relief of suffering caused by prohibitory 
laws must be provided. The courts should care- 
fully consider the facilities at the disposition of 
the communities in which they labor, and in im- 
posing sentences they should be careful not to 
overtax them. It would be better for a com- 
munity to keep a victim upon a steady diet of 
alcohol for weeks while he was waiting for a 
bed in a curative institution than to risk caus- 
ing the man's death or insanity by depriving 
him of his alcohol until the means for relieving 
his system's acute demand for it were at hand. 
By following a similar plan, it will be found that 
the evil of habit-forming drugs can be extermi- 
nated in the United States. Whether alcohol- 
ism, which is a social vice, ever can be similarly 
exterminated by like methods I do not know; 
but I am convinced that an intelligent pursuit of 
such a policy would do more to accomplish the 
desired results than ever has been done by other 
means. 



126 HABITS THAT HANDICAP 

HOW SOCIETY TREATS THE VICTIM OF ALCOHOL 

The care of the inebriate who already comes 
under the law, and who by his habits forces his 
way into the state and municipal hospitals, 
forms one of the great burdens upon society of 
the present day. It should be regarded as one 
of the most important problems of modern 
medicine. 

No other class of the sick includes so great a 
number of individual cases. We find, for ex- 
ample, the almost incredible fact staring us in 
the face that more than one third of all the pa- 
tients admitted to Bellevue Hospital in New 
York City are sent there by alcohol, while less 
than two per cent, are sent there by habit-form- 
ing drugs. 

I am casting no reflection upon this or any 
other institution when I say that there and else- 
where little understanding is shown in dealing 
with these cases. As a matter of fact, no in- 
telligence is anywhere shown in this matter. 
The policeman who finds a drunken man or 
woman on his beat arrests the unfortunate with 
as much wrath and probably as much brutality 
as he would show a burglar or a murderer ; the 
committing' magistrate before whom the victim 



CLASSIFICATION OF ALCOHOLICS 127 

is taken treats him or her precisely as he would 
treat a criminal; in the various penal institu- 
tions to which this man or woman is committed 
the idea upon which their whole treatment is 
based is that of punishment. 

It seems to me that the imperfections of this 
system might most easily be corrected by the 
committing magistrates. It is the largest prob- 
lem which confronts these officials; therefore 
they might very well afford the time necessary 
to study it carefully. Concerted action by this 
group of the judiciary might accomplish worthy 
results almost immediately. As matters are at 
present organized, the committing magistrate 
may do any one of four things with an inebriate 
who has been brought before him: he can re- 
lease him without penalty, he can put him on 
probation, he can fine him, he can imprison him. 
I have yet to discover any one capable of telling 
me why measures of this sort can possibly be 
expected to have a beneficial effect upon a per- 
son who through over-indulgence has set up in 
his system a demand for alcohol. 

I have no wish to appear publicly as the critic 
of our petit judiciary, but no class of men is 
less informed upon this subject — the one sub- 
ject upon which they should be best informed — 



128 HABITS THAT HANDICAP 

than the committing magistrates not only of the 
United States, but of every other country in the 
world. A year or two ago I made a somewhat 
comprehensive European tour, and studied 
carefully the methods of dealing with inebriety. 
Nowhere did I find the faintest indication of a 
tendency for real intelligence in regard to the 
matter. We insist upon special education for 
the professors of our colleges ; yet the influence 
of a committing magistrate upon the human life 
that is brought under his direct sphere of in- 
fluence may be greater even than that of a col- 
lege professor or a college student, and of our 
committing magistrate we make no educational 
demand whatsoever, and have never established 
even a minimum standard of intelligent infor- 
mation for our petit bench. It is my belief that 
expert sociological knowledge should be re- 
quired of every man considered for the impor- 
tant post of committing magistrate. 

RESPONSIBILITY OF THE MAGISTRATE 

The fact that in New York State a colony for 
inebriates has been established by law makes 
this special knowledge more necessary there 
than it was before. Wherever such institutions 
have been founded, and the courts may con- 



CLASSIFICATION OF ALCOHOLICS 129 

tribute to their population by commitment, an 
unintelligent magistrate finds it within his 
power not rarely, but every day, to do more 
harm during one session of his court than he is 
likely to find it within the scope of his intelli- 
gence to do good during the course of a year's 
sitting. I find it impossible to be otherwise 
than bitterly pessimistic in regard to the work 
our courts are doing with alcoholics. 

Under the New York law, a man taken for the 
first time before a magistrate and charged with 
alcoholism must either be fined or told that if he 
again appears charged with that offense, he will 
be subject to commitment to the inebriate farm 
for a period of not less than three months. By 
this procedure not one thing has been accom- 
plished toward the salvation of the man. If he 
is not committed, but is only threatened and or- 
dered to report weekly or oftener to the proba- 
tion officer or the court itself, the greatest of 
all damage has been done, since the man's pride 
has been depreciated. After definite medical 
treatment has been administered to an inebri- 
ate, the only other thing that can be done is to 
make an intelligent appeal to his pride. In this 
appeal is included at least one half the possibili- 
ties of his salvation. Nowhere save in a few 



130 HABITS THAT HANDICAP 

instances in New York City is the alcoholic case 
treated with medical intelligence, and nowhere 
in the world is the balance of the necessary 
treatment — the right appeal to pride — carried 
ont with any degree of common sense. 

I find one system of special horror in this 
treatment of inebriates — com m itting a man for 
three months, then for six months, and then for 
twelve. No more certain means could be de- 
vised to increase the harm done by alcohol to 
the community. Not only does this course fail 
to help the man in any measure whatsoever, but 
it increases the unspeakable harm which his mis- 
fortune must inflict upon his family. In most 
instances such a commitment not only means 
the man's separation from his means of liveli- 
hood for the period of its duration, but his dis- 
charge from it as the result of this utterly in- 
efficient and legally inflicted disgrace. 

The whole effort of society in dealing with 
the alcoholic should be to prevent those things 
which at present are the very ones which it ac- 
complishes — mental depression, loss of pride, 
disgrace, and loss of social position. I am in- 
clined to think that as the world grows older it 
will be more and more convinced of the ineffi- 
ciency of punishment, and more and more aware 



CLASSIFICATION OF ALCOHOLICS 131 

of the necessity of reform through helpfulness. 

It seems obvious that penalization, probation- 
ary influences, or colonization must be utterly 
useless in removing from a man's physical sys- 
tem the craving for alcohol. Therefore it is 
equally obvious that their only successful mis- 
sion must be to remove the victim of drink 
from contact with society for the length of time 
during which his sentence is operative. The 
man who is in all probability incurable is not 
put permanently out of harm's way by these 
means, or placed where he can do no harm ; the 
man who has good stuff in him but who has 
through chance used drugs to excess upon one 
or more occasion is offered by these methods 
nothing in the nature of a fair show toward re- 
gaining his usefulness. 

I see the possibility of many serious results 
in New York's board of inebriety plan. These, 
I think, have their beginning principally in the 
fact that nothing along the line of classification 
has been devised or, as far as I know, has been 
even suggested. If its work were made effi- 
cient by means of the adoption of a plan of 
classification, this board really might become a 
great boon to society. Suppose that instead of 
penalizing the man who has been taken before it 



132 HABITS THAT HANDICAP 

for inebriety, the board, after intelligent and de- 
tailed investigation has shown that the man is 
probably curable, should provide for him the 
necessary definite medical treatment to relieve 
his system from the ill effects of alcohol, and 
then should bring him into contact with psy- 
chological and analytical minds capable of en- 
forcing upon him a realization of the terrible 
meaning of alcoholism. Without having af- 
fected the man's pride it would send him back 
to his family and his task with a cool brain and 
a new point of view. Would not this be a 
vastly better way of dealing with him than those 
which are at present followed ? 

There is no reason why some small charge 
should not be enforced against such benefi- 
ciaries of an enlightened public intelligence who 
might be found able to meet it. This would 
accomplish two things : it would reduce the pub- 
lic expense of the system and it would add very 
greatly to the mental impression left upon the 
mind of the person for whose benefits the State 
was working. Furthermore, if a magistrate 
had once formed the habit of feeling personal 
interest in individual cases probably his first act 
after a man had appeared before him would be 
to send for the accused's employer and make 



CLASSIFICATION OF ALCOHOLICS 133 

the truth of the situation clear to him. The 
mere fact that a man has once been intoxicated 
should not justify his discharge from employ- 
ment in which at normal times he is useful and 
efficient. Both for his sake and for his employ- 
er's, efforts should be made toward reform; for 
it is not infrequently the case that the man who 
has lost control through drink is in normal con- 
ditions the best man in the office, factory, or 
workshop. That is one of the chief tragedies of 
the problem of alcohol. 

There is no subject upon which society more 
sadly needs enlightenment. In this educa- 
tional process it is probable that the magistrate 
will be the largest factor. He must realize that 
he is not society's instrument of vengeance, but 
society's instrument of helpfulness. It should 
be his aim not to punish, but to protect and pre- 
serve. He must realize that scientific knowl- 
edge of the problems which confront him is as 
necessary to his real efficiency as scientific 
knowledge is to the analytical chemist. 

The heart of a conscientious magistrate 
should thrill with a special sympathy, should be 
aware of a great responsibility, whenever there 
appears for judgment in his court a man who 
for the first time has lost control of himself 



134 HABITS THAT HANDICAP 

through drink. To mar this man forever is an 
easy task ; to make him may he difficult, but it is 
certainly not beyond the bounds of possibility. 
The hard drinker who for the first time is 
haled into court as the consequence of intoxica- 
tion never is willing to concede either to him- 
self or to others that he needs help. His soul 
revolts before the mere thought that he has 
more than temporarily, even momentarily, lost 
control. He is likely to deny that he has devel- 
oped a craving for alcohol, and emphatically 
and indignantly to assert that his drunkenness 
has been merely incidental to the social spirit, 
an accident, and in general a thing of no pri- 
mary importance. The thought that without 
help there is even a possibility that he may drift 
from bad to worse is abhorrent to him, and is 
indignantly repudiated. He will cheerfully ad- 
mit that many other men of his acquaintance 
have fallen victims to the effects of alcohol, but 
he will vehemently deny the possibility of a 
similar fall on his own part. The magistrate 
who thoroughly understands all the details of 
the alcoholic's psychology, and who is suffi- 
ciently adroit of mind and speech to take advan- 
tage of this understanding, giving the culprit 
who has been brought before him every benefit 



CLASSIFICATION OF ALCOHOLICS 135 

of a carefully and intelligently organized knowl- 
edge of alcoholism, could not fail to be one of 
the most useful of society's servants and safe- 
guards. 

The man or woman taken before a magistrate 
as the result of alcoholic over-indulgence offers 
a peculiarly perplexing problem. Society has 
placed itself in a highly inconsistent position as 
regards its relation to alcohol. It permits a 
man to pay it for the privilege to sell alcohol to 
any one who asks for it, the only restriction be- 
ing that he may not sell it to a person who al- 
ready has "had too much." This leaves the 
decision as to a customer's needs and capacity, 
as well as perils, to be rendered by the man be- 
hind the bar. Thus to an extent we intrust 
daily the destinies of an appreciable proportion 
of our public to a class of men who certainly 
have done little to earn general confidence. In 
nearly every State, if not in all, laws exist im- 
posing penalties upon the dealer in alcohol who 
sells drink to a person who is already in a state 
of intoxication; but a careful study of the 
records of our courts would fail to reveal any 
large number of liquor dealers who have been 
charged with this offense, while it is obvious 
that most persons found upon the public streets 



136 HABITS THAT HANDICAP 

or elsewhere in a state of intoxication must have 
had alcohol served to them at a time when they 
had already "had enough.' ' As a matter of 
fact, the intelligent mind cannot fail to realize 
that the man who has "had enough' ' invariably 
has had too much. 

This is only one of many reflections which 
must occur to the inquiring mind occupying 
itself with this problem. We have made innu- 
merable laws dealing with, and fondly supposed 
to control, the sale of alcoholic beverages, but 
as a matter of fact only one sort of law has 
ever been devised which possibly could control 
it, and that law provides for absolute prohibi- 
tion. 

THE NEED OF AN ORGANIZED EFFORT TO HELP 
THE ALCOHOLIC 

If the world wishes to be relieved in any meas- 
ure from the human waste attributable to alco- 
hol, the time must speedily arrive when munici- 
palities will recognize it as their duty to provide 
definite medical help for every man who wishes 
to be freed from the craving for alcohol, and 
who cannot afford to pay for treatment. It 
must be recognized that it is society's duty to 
hold out this helping hand to every man who has 



CLASSIFICATION OF ALCOHOLICS 137 

a job and is in danger of losing it through the 
trap which society itself has set for his feet by 
authorizing, and thereby encouraging, the sale 
of alcoholic intoxicants. 

Notwithstanding the presence in our social 
fabric of innumerable charitable bodies, 
churches, religious societies, and other groups 
of people who mean well and work hard to aid 
the unfortunates, it is a fact that nowhere in 
the United States or, as far as I know, anywhere 
else is there a single organization which is ef- 
fectually working along definite and intelligent 
lines for the preservation of the endangered man 
who is still curable. 

No mother, wife, employer, or magistrate can 
effectively reason with a man whose brain is be- 
fogged by alcohol, for that man cannot reason 
with himself. Tears, threats of imprisonment, 
and loss of position do not have upon him their 
normal reaction. He is a sick man whose men- 
tal and physical condition is abnormal ; it must 
be made normal before anything real can be 
done toward his assistance. 

There is but one way out of the sad muddle 
in which alcohol has plunged certain branches 
of our judiciary. In every city must be estab- 
lished emergency hospital wards to which com- 



Icf HABITS THAT HANDICAP 

zzitzing z_:^z:z — zzzj jri . Zczsizs ~itz iz- 
:t^:~t zlizzzii: :r irz^ zistzri-15, 7:z-zzzzzz 
m tzz-5f -""'" -^i v -" r ". ~~ ~zrzs ~~ '." - z-z_-"" — 1 " - 



" - 



., :rr ^ 






The :: — : ziri: :: Qie alcoholic to an or- 

iizzzry ^ri-.. izztinti:z is : ;-:z:j -i:t::t:" 
XLz trzriT::^ ~ zitz ~ ;-.::: v. - zzzzz: — : z- 
zi::-i — itz :z Z -z: ?zztzzzt :: C :rrz:ri:zi ir. i_i 
City :: ."t~ T;:£_^r h.: "iz :".::._ ;zi :". ?/_:•:- 
z'. zziz^i-z:- iziiztZr : :zziiti:z :ii: izis:s 
more or less generally in penal instil l : zs 
tiz :. t ■"_ z :i zztiy. The drug-user or ako- 
z:ii: ~z-: za= \nz ". ; zz. zi in z zriizz i= iz z: 
—2.7 r-ziz-rzi :i izz :n,~i z^ f:z :zi zi:z/z:- 
~zi:_ ijii: zziz.2 zizz. zzi zi- -zz; 11- 1 : : :z.z it 






CLASSIFICATION OF ALCOHOLICS 139 

into a prison than it is alcohol, many alcoholics 
have been changed in prison to drug-takers, and 
after this change the metamorphosis for the 
mere drunkard into an actual criminal has often 
occurred. The administration of a definite 
medical treatment should therefore be regarded 
as imperative in all cases of drug addiction, and 
in most cases of alcoholic addiction that appear 
in our prisons. In the cases of alcoholic addic- 
tions, imprisonment should end, in the case of 
first offenders, with the completion of the treat- 
ment and the restoration of the subject's mind 
to normal. 

I cannot too strongly or too frequently re- 
iterate the statement that there is no more des- 
perate illness than chronic alcoholism. 

Purification from the physical demand for 
alcohol at the place of commitment of men 
taken before the courts upon the charge of in- 
toxication might save the public from a greater 
burden than any other available medical process. 
Drunkenness cannot rightfully be considered as 
a crime as long as society sanctions the sale of 
alcohol and profits by it; therefore the punish- 
ment of alcoholics as criminals is an intolerable 
injustice. That it is also an economic waste is 
as clearly apparent. 



CHAPTER VIII 

THE INJURIOUSNESS OF TOBACCO 

WHEN tobacco was first introduced into 
Europe the use of it was everywhere re- 
garded as an injurious habit, and on this account 
for a while it made slow progress. It is no less 
injurious now than it ever was, — we have simply 
grown used to it, — and it was only when people 
became used to its injuriousness that the habit 
began to make great strides. We find nowadays 
that smokers as well as non-smokers are sus- 
picious of any form of tobacco-taking to which 
they have not become used. Smokers who for 
the first time meet chewers or snuffers or those 
who "dip'" tobacco, as in the South, are affected 
unpleasantly. Smokers keep on finding chewers 
disgusting, and smokers of pipes and cigars fre- 
quently object to the odor of cigarettes. 

Nothing more strikingly illustrates how ad- 
dicted people may become to a habit than the 
smoking and chewing of the traditional South- 
ern gentleman of the old school, whom any other 

140 



INJURIOUSNESS OF TOBACCO 141 

personal uncleanliness would have horrified. 
Young men most fastidious about their apparel 
seem quite unaware that it is saturated with the 
smell of tobacco. The odor of a cigarette is 
probably as offensive to some of those who do 
not smoke as any other smell under heaven. 
Yet such is the power of habit that we tolerate 
all these things. 

If we could begin all over again, we should 
find the same general objection to smoking that 
existed in Europe when the habit first began. 
Our chief need, then, is a new mind on the sub- 
ject. How can we get it? 

The circumstance of my giving up smoking 
eighteen years ago may have some slight sig- 
nificance in this connection. I was smoking 
hard, and began to have a vague feeling that it 
was hurting me. I had been playing whist at a 
late hour in my room at a hotel, and when I 
finally went to bed I could not sleep for a long 
while. I awoke with a bad taste and a parched 
mouth in a room heavy with stale smoke and un- 
sightly with cigar-butts lying everywhere. Sud- 
denly a disgust for the whole habit seized me, 
and I broke off at once and completely. After 
a week or so, when the first feeling of seediness 
and uneasiness and depression had worn away, 



142 HABITS THAT HANDICAP 

I found my appetite and concentration and in- 
itiative increasing. You will observe that it 
was not until I began to regard smoking as 
harmful that I saw it was also filthy. I had a 
new mind on the subject. 

I am trying to give my readers a new mind on 
the subject, and if they have not come to suspect 
the evil of smoking, they will naturally ask me 
to prove that it is harmful. 

Let us begin at the bottom. 

Does it do any one any physical good? Argu- 
ments in favor of tobacco for any physical rea- 
son are baseless. It does not aid digestion, pre- 
serve the teeth, or disinfect, and it is not a 
remedy for anything. The good it does — and 
no habit can become general, of course, unless it 
does apparent good — can only be mental. Let 
me admit at once that smoking confers mental 
satisfaction. It seems to give one companion- 
ship when one has none, something to do when 
one is bored, keeps one from feeling hungry 
when one is hungry, and blunts the edge of hard- 
ship and worry. This sums up the agreeable re- 
sults of tobacco. There are one or two more 
specialized agreeable results which I exclude at 
this moment because they are only temporary. 
The results I mention — let me admit at once — 



INJURIOUSNESS OF TOBACCO 143 

are real, and both immediate and apparent. On 
the other hand, the injurious results, after one 
has become inured to tobacco poison, are both 
unapparent and delayed. 

THE PHYSIOLOGICAL ACTION" OF TOBACCO 

As to the physiological and toxic effects of 
tobacco there is much difference of opinion. 
Everybody knows that the first chew or the first 
smoke is apt to create nausea ; and that no mat- 
ter haw long a man has been smoking, a little 
lump of the tar which has collected in his pipe 
will sicken him. Nicotine is in itself highly 
toxic, but is very volatile and is absorbed only 
from the portion of the cigar or cigarette held 
in the mouth. The products of combustion of 
tobacco are chemical substances which are also 
toxic, and nausea naturally stops the smoker 
before symptoms of acute poisoning result. 
One must look, then, for symptoms of slow poi- 
soning. The popular belief that tobacco stunts 
growth is supported by the fact that non-smok- 
ers observed for four years at Yale and Am- 
herst increased more in weight, height, chest- 
girth, and lung capacity than smokers did in the 
same period. 

Every athlete knows that it hurts the wind; 



144 HABITS THAT HANDICAP 

that is. inyares th :e heart : : : :r :nd 

quickly : : extra work. It also affects the pre- 
cision of eye and hand. A great billiard-pla7 si 
who does not smoke once assnred me that he 
felt sure of winning when his opponent was a 
smoker. A tennis-player began to smoke at the 
age oi twenty-one, and found that men whom he 
had before beaten with ease could now beat him. 
Sharp-shooters and riflemen know that their 
shooting is more accurate when they do not 
smohe. But yon may say: "The athletes a: 
billiard-players and the rest are experts. I ani 
an average man, making average use of my 
facilities. Besides. I an net contending 1 that en- 
e he smoking is n't injurious, and I will even 
9oncede that the limit of excess varies with the 
man. -DUtisrtnot ime tna. n^.rm_u- resn.ts o_ 
average smoking for the average man are 
rare ! ' ' 

In ans~er. let me on my side admi: that they 
are — the apparent harmful results. 

We are, however, very ignorant of the effect 
of small, continued doses of the various toba 
poisons. All drugs comparatively harmless. 
snch as lead, mercniy. ane arsem:. tr::h 
highly injurious e±e:t ~h-n tahen in tee eared 
small doses. Just what effect the use of toba : 



INJURIOUSNESS OF TOBACCO 145 

engenders we cannot absolutely know, but no 
physician doubts that smoking may be a factor 
in almost any disease from which his patient is 
suffering. 

There can be, for instance, no question that 
smoke simply as smoke irritates the mucous 
membrane of the bronchial tubes and renders 
them more susceptible to infections; by irri- 
tating the mucous membrane of the nose and 
throat it tends to produce catarrh and therefore 
catarrhal deafness. It would therefore seem 
fair to state that the man who does not use to- 
bacco is less susceptible to disease and con- 
tagion, and recovers more quickly from a serious 
illness or operation. From this we should ex- 
pect to find that tobacco shows most in later life, 
when vitality is ebbing and the machinery of the 
body is beginning to wear. It is in his middle 
age that a man begins to feel the harm. In 
short, though we know only the precise or im- 
mediate effect of nicotine and only some of the 
morbid processes which excessive smoking may 
produce, it is likely that the worst aspect of to- 
bacco is something that we do not know very 
much about — its tendency to reduce a man's 
general vigor. 

The dominant characteristic of tobacco is the 



146 HABITS THAT HANDICAP 

fact that it heightens blood-pressure. The irri- 
tant action by which it does this sometimes leads 
to still more harmful results. Its second action 
is narcotic: it lessens the connection between 
nerve-centers and the outside world. These two 
actions account for all the good and all the bad 
effects of tobacco. As a narcotic, it temporarily 
abolishes anxiety and discomfort by making the 
smoker care less about what is happening to 
him. But it is a well-known law of medicine 
that all the drugs which in the beginning lessen 
nerve-action increase it in the end. Thus smok- 
ing finally causes apprehension, hyper-excita- 
bility, and muscular unrest. Here this inevit- 
able law seems to give contradictory results. 
Every physician knows that an enormous 
amount of insomnia is relieved by smoking, 
even if it is at the expense of laziness the next 
day; at the same time every physician knows 
that most excessive smokers are troubled with 
insomnia. 

CIGARETTES 

In using tobacco we take the poison into the 
tissues. The chewer and the snuffer get the 
effect through the tissue with which the tobacco 
comes, in contact. The cigarette-smoker almost 



f 



INJURIOUSNESS OF TOBACCO 147 

invariably inhales, and he gets the most harm 
merely because the bronchial mucous membrane 
absorbs the poison most rapidly. The tobacco 
itself is no more harmful than it is in a pipe or 
a cigar. Indeed, it is often less so in the cheaper 
grades, for, being less pure, it contains less nico- 
tine. Furthermore, the tobacco is generally 
drier in a cigarette, and for that reason the com- 
bustion is better, for the products of the combus- 
tion of dry and damp tobacco are not the same. 
But since it is a little difficult to inhale a pipe or 
a cigar without choking, the smoke products of 
a pipe or cigar are usually absorbed only by the 
mouth, nose, and throat, whereas the inhaled 
smoke of the cigarette is absorbed by the entire 
area of windpipe and bronchial tubes. If you 
wish to see how much poison you inhale, try 
the old experiment of puffing cigarette smoke 
through a handkerchief, and then, having in- 
haled the same amount of smoke, blow it out 
again through another portion of the same hand- 
kerchief. The difference in the discoloration 
will be found to be very marked. You will note 
that in the second case there is hardly any stain 
on the handkerchief : the stain is on your wind- 
pipe and bronchial tubes. 
If a man inhales a pipe or a cigar, he gets 



14S HABITS THAT HANDICAP 

more injury simply because he gets stronger to- 
bacco ; bnt a man never inhales a pipe or a cigar 
unless he is a smoker of long standing or unless 
he ha s begun with cigarette s . B e b ides allowing 

one to inhale, a cigarette engenders more mas- 
cause of its shortness, cheapness, and conven- 
ience, one lights a hgumtce. throms it o~:m. and 
then lights another. This spasmodic process, 
constantly rereateh increases the smcher's rest- 

a feeling that he is doing some* Yet de- 

spite the fact that cigarette- smoking is the worst 
form of tobacco addiction, virtually all boys who 

smthe -tart vmh cigarettes. 
It is generally believed that in the immature 

the m: derate nse of tthamo stttnts me normal 
m : — :h :f the :: : ;Iy and mind, and causes vari- 
ous nervons clismrh turns, em e holly 01' the heart 
— disturbances which it muses in later life only 
when miming has he come excessive. That is to 
sty, though a boy's stomach grows tolerant 
of nicotine to the extent of taking it without 
protest, the rest of the 1 : :Iy keer - on protesting. 
Furthermore, many business men will tell you 
that tobacco damages a ley's usefulness in his 
work. This is uecemarilv so. since anvthinsr 



INJUEIOUSNESS OF TOBACCO 149 

wliicli lowers vitality creates some kind of in- 
competence. For the same reason the boy who 
smokes excessively not only is unable to work 
vigorously, but he does not wish to work at all. 
This result, apparent during growth, is only less 
apparent after growth, when other causes may 
step in to neutralize it. Tobacco, in bringing 
about a depreciation of the nerve-cells, brings, 
together with physical results like insomnia, 
lowered vitality, and restlessness, their moral 
counterparts, like irritability, lack of concentra- 
tion, desire to avoid responsibility and to travel 
the road of least resistance. If there were some 
instrument to determine it, in my opinion there 
would be seen a difference of fifteen per cent, in 
the general efficiency of smokers and non- 
smokers. The time is already at hand when 
smokers will be barred out of positions which 
demand quick thought and action. Already to- 
bacco is forbidden during working hours in the 
[United States Steel Corporation. 

Many men were prejudiced against smoking 
until they went to college. There they found 
themselves "out of it" because they did not 
smoke. More than that, they found that the 
smoke of social gatherings irritated their eyes 
and throat, and they thought that smoking might 



150 HABITS THAT HANDICAP 

keep tlieni from finding other people 's smoke an- 
noying. A man who had left off smoking told 
me that at the first "smoker" he attended after- 
ward he fonnd the air offensive and his eyes 
smarting intolerably, although when he had been 
helping to create the clouds in which they were 
sitting he had not noticed it at all. These two 
experiences are common. For this reason, the 
social inducements to smoking are considerably 
greater than those to drinking. The man who 
refuses to drink may feel as much "out of it" 
as the man who refuses to smoke, but he has or- 
dinarily, and in the presence of gentlemen, no 
other penalty to pay. He undergoes no discom- 
fort in spending the evening in a roomful of 
drinkers, and he can manage to find things to 
drink that will have for them the semblance of 
good-fellowship. It is the social features that 
attend the acquiring and the leaving-off the 
habit which make smoking difficult to attack. In 
its present state, even if a boy were thoroughly 
familiarized in school with the harm tobacco 
would do him, he would still be seduced by the 
social side of it. 1 

1 1 have heard of a New Yorker who gave up his attendance 
as a member of the executive committee of a prominent and 
very useful reform association because, though an occasional 



INJUBIOUSNESS OF TOBACCO 151 

When a habit fosters or traditionally accom- 
panies social intercourse, it is all the harder to 
uproot. 

What grounded opium so strongly in China 
was its social side. The Chinese lacked social 
occupation, and it was not the custom of the 
country for a man to find it with his friends and 
family, though no people are more socially in- 
clined. Smoking opium became their chief so- 
cial activity; they gathered together in the one 
heated room of the house to gossip over their 
pipes. We smoke tobacco as the Chinese smoke 
opium, "for company" and in company. Thus 
one must provide strong reasons to make a man 
give it up. He will not do so because it costs 
him something ; he expects to pay for his pleas- 
ures. When a man has actually gone to pieces, 
it is comparatively easy to convince him that he 
ought to give up what is hurting him; but the 
average man has not been excessive enough for 
that, and has never brought himself to the point 
of serious conscious injury. Even a physician 
cannot with any certainty tell the average mod- 
smoker, he could not endure the tobacco-laden atmosphere of 
the room where the committee met. 

To this day his associates probably think him a very luke- 
warm worker in the cause! 



152 HABITS THAT HANDICAP 

erate smoker whether tobacco is hurting him. 
Consequently, if one would make this man stop 
smoking, especially when he sees that leaving 
off has caused some people more apparent dis- 
comfort than all their smoking did, one's only 
chance is to make him change his mental atti- 
tude. I hope to assist in doing this by calling 
attention to the fact that tobacco not only pre- 
pares the way for physical diseases of all kinds, 
as any physician will tell you, but also, as long 
investigation has shown me, for alcoholism and 
for drug-taking. 

TOBACCO, ALCOHOL, AXD OPIUM 

The relation of tobacco, especially in the form 
of cigarettes, and alcohol and opium is a very 
close one. For years I have been dealing with 
alcoholism and morphinism, have gone into their 
every phase and aspect, have kept careful and 
minute details of between six and seven thou- 
sand cases, and I have never seen a case, except 
occasionally with women, which did not have a 
history of excessive tobacco. It is true that my 
observations are restricted to cases which need 
medical help, — the neurotic temperaments, — but 
I am prepared to say that for the phlegmatic 
man, for the man temperamentally moderate, 



INJURIOUSNESS OF TOBACCO 153 

for the outdoor laborer, whose physical exercise 
tends to counteract the effect of the tobacco and 
the alcohol he uses — in short, for all men, to- 
bacco is an unfavorable factor which predis- 
poses to worse habits. A boy always starts 
smoking before he starts drinking. If he is dis- 
posed to drink, that disposition will be increased 
by smoking, because the action of tobacco makes 
it normal for him to feel the need of stimulation. 
He is likely to go to alcohol to soothe the mus- 
cular unrest, to blunt the irritation, he has re- 
ceived from tobacco. From alcohol he goes to 
morphine for the same reason. The nervous 
condition due to excessive drinking is allayed by 
morphine, just as the nervous condition due to 
excessive smoking is allayed by alcohol. Mor- 
phine is the legitimate consequence of alcohol, 
and alcohol is the legitimate consequence of to- 
bacco. Cigarettes, drink, opium, is the logical 
and regular series. 

The man predisposed to alcohol by the in- 
heritance of a nervous temperament will, if he 
uses tobacco at all, almost invariably use it to 
excess ; and this excess creates a restlessness for 
which alcohol is the natural antidote. The ex- 
perience of any type of man is that if he takes a 
drink when he feels he has smoked too much, he 



154 HABITS THAT HANDICAP 

finds he can at once begin smoking all over 
again. For that reason, the two go together, 
and the nenrotic type of man too often combines 
the two. Tobacco thus develops the necessity 
for alcohol. 

It is very significant that in dealing with al- 
coholism no real reform can be expected if the 
patient does not give np tobacco. Again, most 
men who have ever nsed alcohol to excess, if re- 
stricted voluntarily or involuntarily, will use 
tobacco to excess. This excess in tobacco pro- 
duces a narcotic effect which temporarily blunts 
the craving for alcohol. Another way of saying 
the same thing is that when smokers are drunk 
they no longer care to smoke, a fact that is a 
matter of common observation. This means 
that there is a nervous condition produced alike 
by alcohol and tobacco. When a man gets it 
from drinking, he does not keep on trying to get 
it from smoking. As well as reacting upon each 
other, the two habits keep each other going. It 
is not altogether by haphazard association that 
saloons also sell cigars; they sell them for the 
same reason that they give away pretzels — to 
make a man buy more drinks. 

This relationship between tobacco and alco- 
holism is not understood by the public. It has 



INJUKIOUSNESS OF TOBACCO 155 

been absolutely demonstrated that the continued 
use of tobacco is a tremendous handicap upon 
the man who is endeavoring to free himself from 
the habit of alcoholic indulgence. Only a man 
of the strongest character will persist in abstain- 
ing from alcohol unless he also abstains from 
tobacco, even after he has undergone the most 
intelligent medical treatment. In the system of 
a man already disposed toward alcoholic stim- 
ulation, no one thing will prove so positive a 
factor toward creating the sense of need as the 
use of tobacco. Physiological action of tobacco 
is to create muscular (motor) unrest. Most 
habitual smokers consume every day more than 
enough tobacco to carry them far beyond the 
point where its stimulating effect ends and its 
narcotic effect begins. Where this habitually 
occurs, the definitely toxic effect is notable, and 
this results in a demand for that stimulation 
which the tobacco itself once furnished, but now 
does not. Here is an evil effect of tobacco that 
is rarely understood and almost never admitted. 

OPIUM AND CIGAKETTES IN CHINA 

Current history affords us a striking proof of 
the closeness of the relation between tobacco 
and opium. 



156 HABITS THAT HANDICAP 

I have spent a good deal of time in the Orient 
in the interest of those who were trying to sub- 
due the opium evil, and I may add that there is 
in China to-day a flourishing American tobacco 
concern which has grown rich out of the sale of 
cigarettes. With the extremely cheap Chinese 
labor, the concern was able to sell twenty ciga- 
rettes for a cent of our money. Up to the be- 
ginning of this enterprise (about 1900), the 
Chinese had never used tobacco except in pipes, 
and in very minute quantities in rolling their 
own crude cigarettes. The concern was sending 
salesmen and demonstrators throughout the 
country to show the people how to smoke ciga- 
rettes. Now it is estimated that one half of the 
cigarette consumption of the world is in China. 
In trying to lessen the opium evil, in which they 
have to a considerable extent succeeded, the 
Chinese are merly substituting the cigarette evil. 
It is well known to the confirmed opium-smoker 
that he needs less opium if he smokes cigarettes. 
The Chinese to-day are spending twice as much 
money for tobacco as for opium. 

I once said to a Chinese public man: "I can 
help you to get rid of the opium habit because 
you have found that you must get rid of it, but 
I cannot help you to get rid of the evil you are 



INJURIOUSNESS OF TOBACCO 157 

substituting for it, for not even America has yet 
found out that she must get rid of it. Your 
cure, I fear, is worse than your disease ; and our 
disease has no cure — until we change our mental 
attitude.' ' 

If any one thinks that China is the gainer by 
substituting the one drug habit for the other, I 
beg leave to differ with him. The opium-smoker 
smokes in private with other smokers, and is 
thus not offensive to other people. He is not 
injuring non-smokers, or arousing the curiosity 
of boys, or polluting the atmosphere, or creating 
a craving in others. In the West the opium 
habit is generally condemned because the West 
is able to look with a new and unbiased mind on 
a drug habit that is not its own. 

I consider that cigarette-smoking is the great- 
est vice devastating humanity to-day, because it 
is doing more than any other vice to deteriorate 
the race. 

LIKE ACTION OF THE THREE HABITS 

The more you compare smoking and drinking 
and drugging, the more resemblances you see. 
Opium, like tobacco and alcohol, ceases to stim- 
ulate the moment the effect of it is felt: it then 
becomes a narcotic. The history of the three 



158 HABITS THAT HANDICAP 

as a resort in an emergency is precisely the 
same. At the time when the average man feels 
that he needs his faculties most, he will, if ad- 
dicted to any of the three, deliberately seek 
stimulation from it. He does not intend to go 
on long enough to get the narcotic effect, since 
that would be clearly defeating his own aims ; he 
means to stop with the stimulant and sedative 
effect, but that he is unable to do. The inhaler 
of tobacco gets his effect in precisely the same 
way that the opium-smoker gets his — the rapid 
absorption by the tissues of the bronchial tubes. 
It may be news to the average man to hear that 
the man who smokes opium moderately suffers 
no more physical deterioration than the man 
who inhales tobacco moderately. The excessive 
smoker of cigarettes experiences the same men- 
tal and physical disturbance when deprived of 
them that the opium-smoker experiences when 
deprived of opium. The medical treatment 
necessary to bring about a physiological change 
in order to destroy the craving is the same. 
The effect of giving up the habit is the same — 
cessation of similar physical and nervous and 
mental disturbances, gain in bodily weight and 
energy, and a desire for physical exercise. A 
like comparison, item for item, may be made 



INJURIOUSNESS OF TOBACCO 159 

with alcohol, but it is the similarity with opium 
which I wish particularly to emphasize here. 

TOBACCO AND MOKAL SENSITIVENESS 

Morphine, as is very well known, will distort 
the moral sense of the best person on earth; it 
is part of the action of the drug. Since the way 
morphine gets its narcotic effect is very similar 
to the way tobacco gets its effect, one would nat- 
urally suppose that tobacco would produce in a 
milder degree something of the same moral dis- 
tortion. This may seem a startling conclusion, 
but change your mental attitude and observe. 
Have not smokers undergone a noticeable moral 
deterioration in at least one particular? They 
have a callous indifference to the rights of 
others. This happens with all habitual indul- 
gence, of course, but is it not carried more gen- 
erally to an extreme with tobacco than with any- 
thing else? Few men quarrel with a hostess 
who does not offer them drinks, but all habitual 
smokers expect that, regardless of her own de- 
sires, she will let them smoke after dinner. 

"We gave up the fight against tobacco in our 
drawing-rooms long ago," said a famous Lon- 
don hostess. "We found it was a case of no 
smoke, no men." 



160 HABITS THAT HANDICAP 

Eespectable men in New York City who would 
not dream of deliberately breaking any other 
law carry cigars and cigarettes into the subway 
despite the fact that it is forbidden and that it 
is vitally necessary to keep the air there as pure 
as possible. A gentleman is more annoyed at 
being forced to consult another's preference 
about not smoking than about anything else that 
could arise in social intercourse, and is often at 
small pains to conceal his impatience with old- 
fashioned people who believe they have rights 
which should be respected. 

On all sides the attitude seems to be, "What 
right has any one to object to my smoking V 9 
The matter is really on just the opposite basis, 
"What right has any one to smoke when other 
people object to it?" 

If a man must get drunk, we say he shall get 
drunk where he is a nuisance only to himself 
and to others of the same mind. If a man feels 
the need of interlarding his conversation with 
obscenity and grossness, we say he may not com- 
pel us to listen to him. But a smoker may with 
impunity pollute the air, offend the nostrils, and 
generally make himself a nuisance to everybody 
in his neighborhood who does not practise his 
particular vice. Is this not a kind of moral 



INJURIOUSNESS OF TOBACCO 161 

obtuseness? Change your mental attitude and 
consider. 

The action of a narcotic produces a peculiar 
cunning and resource in concealment; it de- 
velops, when occasion arises, the desire to de- 
ceive and, whether occasion arises or not, the 
desire to shift obligation and evade direct re- 
sponsibility. Tobacco does this more mildly 
than opium, and it does so more appreciably 
with boys than with men ; but, as with opium, it 
is part of the narcotic effect in all cases. 

Let it always be remembered that if a man 
smokes and inhales tobacco excessively he is 
narcotizing himself more than when he smokes 
opium moderately. 



CHAPTER IX 

TOBACCO AND THE FUTURE OF THE RACE 

NEVER yet has tobacco done any good to a 
man. Its direct effect has been harmfu] 
to millions, and indirectly it has harmed many 
other millions by setting up a systematic de- 
mand for stimulants. Of all the widely used 
products of nature, tobacco finds the least ex- 
cuse in real necessity. Virtually the only med- 
ical use to which the active principle of tobacco 
(nicotine) can be put is the production of nau- 
sea, and there are many other drugs that can 
be used with much better effect for that pur- 
pose. If one will study the pharmacopoeia, he 
will find that, next to prussic acid, nicotine is 
rated as the most powerful known poison, and is 
not credited with a single curative property. 
From a medical point of view it is valueless. 

The social standing of the man who took it 
from the tepees of the North American Indians 
to England is mainly responsible for its taking 
root there, for the acquisition of the tobacco 

162 



TOBACCO AND FUTURE OF RACE 163 

habit is a painful process. Nature's revolt 
against it is much more instinctive than her re- 
volt against alcohol. Furthermore, like any- 
other form of poison, its effects are most im- 
mediate and evident upon the young and weak ; 
for they are easier to poison than the mature 
and strong. 

THE FULL EFFECT OF THE TOBACCO HABIT 
IS NOT YET APPARENT 

To one who has made a careful study of the 
effects of tobacco the prospect for the future is 
not encouraging. The habit was already wide- 
spread before the extensive manufacture, or 
even knowledge, of cigarettes was introduced 
into the United States, and this later form of 
smoking, which is easily the most obnoxious and 
harmful of all, has not yet had time to disclose 
its full power for injury. For it is in the in- 
haling of tobacco that the smoker receives his 
greatest injury, and the habit of inhalation is 
peculiar to the cigarette-smoker. While there 
are smokers of cigars and pipes who inhale their 
smoke, it will almost always be found upon in- 
vestigation that they acquired the habit of in- 
halation through smoking cigarettes. The aver- 
age man with a cigarette history gets no pleas- 



164 HABITS THAT HANDICAP 

ure out of smoke which he does not inhale. 
Even if a cigarette is made of the best to- 
bacco, undrugged, and wrapped in the purest 
of rice-paper, the mere fact that the smoke is 
almost invariably inhaled suffices to make ciga- 
rette-smoking the most harmful form of the to- 
bacco habit. Inhalation is harmful because it 
not only exposes the absorbent tissues of the 
mouth and upper throat to the smoke, but 
thrusts the smoke throughout the throat, lungs, 
and nose, all of which are lined with a specially 
sensitive membrane of great absorptive capac- 
ity. Thus from the smoke of the cigarette the 
system takes up many times as much poison as 
it takes up from the uninhaled smoke of the pipe 
or cigar. Indeed, it may be added that the 
purer and higher the grade of the tobacco, the 
more harmful it is to the smoker, for the more 
will it tempt him into inhalation. Another 
danger of certain brands of cigarettes, prin- 
cipally the costly imported and specially 
flavored brands, is that to the extraordinary 
dangers of nicotine-poisoning found in all ciga- 
rettes are added in these higher grades the 
perils of their flavoring materials, from which 
even so dangerous a drug as opium is not always 
absent. 



TOBACCO AND FUTURE OF EACE 165 

I believe that the evil effects of tobacco will 
be much more apparent in the next generation 
than they are in this ; for forty years ago, when 
I was a boy, the lad who decided to begin to 
smoke knew nothing of cigarettes, and had only 
the pipe and the cheap cigar to choose between, 
forms so overpowering that they frequently dis- 
couraged him at the start. Thus many were un- 
doubtedly saved from the tobacco habit; but 
now, with mild cigarettes upon the market, at 
very low prices, and in most States found on 
sale in every candy store, the situation has perils 
undreamed of at that earlier period. It is note- 
worthy that cigarettes are " doped" expressly 
to allay nausea, which is the normal effect of 
tobacco-smoking upon the uninured human sys- 
tem, and at the same time to quiet that motor 
unrest which is the first symptom to follow the 
introduction of nicotine into the human system. 
The narcotic effect of the adulterant drugs is 
therefore to ease the smoker's first pang and to 
make him more quickly the victim of the tobacco 
habit. 

The smoker of cigarettes gets his narcotic by 
precisely the same mechanical process through 
which the opium-smoker gets his. The opium- 
smoker would find it far too long and expensive 



166 HABITS THAT HANDICAP 

a process to obtain the desired effect from opium 
by taking it into his stomach; hut by burning 
a very much smaller quantity of the drug and 
bringing it into contact with the sensitive ab- 
sorbent tissues of the throat and nose, he obtains 
the narcotic effect that his system craves. 

THE USE OF TOBACCO DESTROYS MORAL 
DISCIPLINE 

I am convinced that the use of cigarettes is 
responsible for the undoing of seventy-five per 
cent, of the boys who go wrong. Few boys wait 
until they are mature and their resistance is at 
its maximum before they begin the use of to- 
bacco. It would be remarkable if they did wait, 
for their fathers and their older brothers are 
constantly blowing smoke into their faces. 
Even where restrictive laws exist, minors find 
no difficulty in obtaining cigarettes, so that chil- 
dren of the age that is most easily harmed by 
the use of tobacco now habitually indulge in its 
most harmful form. 

There is another unfortunate effect of the use 
of tobacco by boys. When they begin to smoke, 
they do so against the wishes and usually 
against the orders of their parents. This 
means broken discipline and deception. The 



TOBACCO AND FUTURE OF RACE 167 

boy who endeavors to conceal the fact that he 
smokes is started along a path that is even more 
harmful than tobacco. He has to invent excuses 
for being absent from home, and to explain away 
the odor of tobacco that is sure to cling to him ; 
and when a boy begins to lie about these things, 
he will lie about others. So far as truth goes, 
the bars are down. Furthermore, he has to 
spend more money. Unless he is one of those 
unfortunate youths who are not held to a mod- 
erate weekly allowance, too often he will resort 
to dishonest means to obtain the money to 
satisfy his newly acquired taste. 

And that is not all. Boys who spend their 
time in smoking go where they will find other 
lads also engaged in the forbidden habit. They 
find congenial groups in pool-rooms, where they 
learn to gamble, and in the back rooms of 
saloons, where they learn to drink. The step 
from the pool-room or the saloon to other gam- 
bling-places and to drinking-places frequented 
by the unworthy of both sexes is an easy one. 
Thus the boy whose first wrong-doing was the 
smoking of cigarettes against the wishes of his 
parents soon becomes the target for all manner 
of immoral influences. 

In these days of advanced sociological study, 



168 HABITS THAT HANDICAP 

when the mind of the world is set upon efficiency, 
it is astonishing that so little attention has been 
given to the effect of tobacco upon the young. 
To mankind at the present time nothing in the 
world is so important as the conservation of the 
boy. Humanity might well make any sacrifice 
conceivable in order to keep its boys clean. 
Keeping boys clean means keeping girls clean, 
and whatever keeps boys and girls clean purifies 
humanity as a whole. In other words, the boy 
is the most important thing in the world, and 
his cleanliness the most vital issue. Setting 
aside entirely the deleterious effect of nicotine 
upon his physical system, early smoking, which 
usually means the cigarette, is the most harm- 
ful single influence that is at present working 
against his welfare. We can appreciate the ter- 
rific total harm which tobacco does to youth, how- 
ever, only when we add the psychological harm 
and the physical harm together. Everything 
considered, the question is an appalling one. 

THE TEMPTATION TO USE TOBACCO 

It is impossible to blame most boys very se- 
verely for yielding to the smoke-temptation; 
therefore it becomes a difficult matter to blame 
them for the wrong-doing which tends to follow 



TOBACCO AND FUTURE OF RACE 169 

it. Their error is only the continuation of a 
similar error that their fathers have made be- 
fore them and now tacitly encourage. It is diffi- 
cult to make any lad believe that he need not be 
a fool because his father is one. Yet in most 
cases to save a boy from the demonstrable ills 
of tobacco-using entails just this course of rea- 
soning. Orators and essayists from the begin- 
ning of time have found a stumbling-block in 
preaching to their followers virtues they admire 
and value, but do not themselves possess. The 
father who forbids his son to smoke because it is 
harmful and expensive, while his own person 
reeks with it, is not likely to impress the lad 
very vividly with either the force or the honesty 
of his argument. More than one parent has 
found himself abashed in such circumstances by 
a son with logic and intelligence. For such a 
parent there is only one really honest course — 
to admit to his son that he himself has been a 
fool, but that he does not wish his son to follow 
in his footsteps. 

THE NECESSITY OF EDUCATION CONCERNING 
THE DANGER OE TOBACCO 

There is no question in my mind that this 
matter of tobacco should be made the basis of 



170 HABITS THAT HANDICAP 

a very thorough educational campaign among 
the youth of the United States. The shocking 
spread of the tobacco habit among the women 
of American cities indicates, moreover, need for 
extending this instruction to girls as well. 

If cleanliness of body is next to godliness, 
then cleanliness of mind is godliness, and clean- 
liness of mind, real cleanliness, is impossible 
while ignorance exists. Nothing in education is 
more generally neglected than the enlightenment 
of the young — an enlightenment which can come 
only from the mouths of elders who are them- 
selves clean — as to the deadly nature of alcohol, 
habit-forming drugs, and tobacco. I should 
very much dislike to send a young and impres- 
sionable son for instruction in any subject to 
any teacher, male or female, who used ciga- 
rettes. Thousands upon thousands of parents 
in this country feel as I do on this subject ; but 
while they realize the danger which might re- 
sult from the influence of a teacher who smokes, 
they utterly neglect the far more dangerous and 
powerful influence of a father who smokes. To 
my mind, however, it is essential that parents 
should seriously consider the personal character 
of the men to whom they intrust the education 
of their boys. 



TOBACCO AND FUTUBE OF RACE 171 

But the use of tobacco reaches far beyond the 
home circle and the schools and even pollutes 
the atmosphere of the church itself. There are 
few clergymen in the United States who do not 
use tobacco, and so a clean father who rears a 
clean son is under the tragic necessity of urging 
his attendance at a dirty church, and later on 
sending him to be a student in a dirty college, 
for the simple reason that there are no clean 
ones. 

Society seems to have been viciously organ- 
ized for the destruction of the boy, in whom lies 
its chief hope of preservation and improvement. 
The boy who keeps clean does so against tre- 
mendous odds, to which frequently his father, 
his school-teacher, and his clergyman are the 
chief contributors. A dozen times during every 
day of his life he is subjected to the third de- 
gree of temptation, and twice out of three times 
this ordeal is thrust upon him by the very per- 
sons who really should do most to safeguard 
and protect him. And now that society has set 
its sanction upon the use of tobacco by the 
women of the nation, he is confronted with the 
further peril of a mother who smokes. It seems 
to me that this tobacco question detracts enor- 
mously from that very vivid hope we might feel 



172 HABITS THAT HANDICAP 

for the rising generation, which is also handi- 
capped with alcohol and drugs. 

TOBACCO ADDICTION" MOKE DANGEBOUS THAN DKUG 
HABIT OE ALCOHOLISM 

I have no desire to moralize upon the subject 
of tobacco. I am not a moralist, but a prac- 
tical student of cause and effect, urging the 
elimination of bad causes so that bad effects 
may be eliminated in turn. A very wide 
experience in studying the result of the use 
of narcotics has convinced me that the total 
harm done by tobacco is greater than that done 
by alcohol or drugs. Nothing else at the 
present time is contributing so surely to the 
degeneration of mankind as tobacco, because, 
while its damage is less immediately acute than 
that done by alcohol or habit-forming drugs, it 
is, aside from its own evil effects, a tremendous 
contributory factor to the use of both. There 
is nothing to be said in its favor save that it 
gives pleasure, and this argument has no more 
force in the case of tobacco than in the case of 
opium. Any man who uses tobacco poisons 
himself, and the very openness and permissi- 
bility of the vice serve to make the process of 
self-poisoning dangerous to the public as well. 



TOBACCO AND FUTURE OF RACE 173 

To sum up, the tobacco habit is useless and 
harmful to the man who yields to it ; it is mal- 
odorous and filthy, and therefore an infringe- 
ment upon the rights and comforts of others. 
Its relation to alcohol is direct and intimate. 
When an alcoholic comes to me for treatment, I 
do not regard my chances of success with him as 
good unless I can make him see that to abandon 
smoking is a necessary step in his treatment. 
My deductions concerning the intimate relation- 
ship between the use of tobacco and liquors are 
the result of years of observation and study. 
And if it is true that no man whose system is 
alcoholic is fit to be the father of a child, it is 
no less true that the habitual smoker is also un- 
worthy to be a guardian of his kind. The alco- 
holic fiend almost invariably becomes the parent 
of children provided with defective nervous sys- 
tems, of children as definitely deformed nerv- 
ously as they would be physically if born with 
club-feet or hare-lips. 



CHAPTER X 

THE SANATORIUM 

THERE is no class of patients in the world 
to whom the physician, and especially the 
physician who conducts a sanatorium, can offer 
so good an excuse for long-continued treatment 
as to those addicted to the use of drugs. It is 
certain that the person who makes a weekly 
charge to such patients is rarely honest with 
them or tries to shorten their stay. Several 
years ago I freely and without reservation gave 
all the details of my treatment to the medical 
world, and though many institutions have en- 
deavored to install it as a part of their own cura- 
tive policy, most have failed. The failure may 
be attributed principally, if not wholly, to the 
fact that few have also adopted the necessary 
principle of a fixed charge, without regard to the 
length of time the patient is under treatment. 
The weekly charge, with its attendant tempta- 
tion to keep the patient as long as possible, has 
invariably defeated all possibilities of success. 

174 



THE SANATOEIUM 175 

There is also a class of institutions in which 
the "cure" for the drug habit consists in the 
administration of the drug itself in a disgmised 
form. In such surroundings a patient will con- 
tentedly stay indefinitely, for the chains of his 
habit bind him to the spot. The very fact that 
he wishes to stay may be accepted as a proof 
that he has not been benefited by it. For the 
man who has been freed from a drug habit de- 
sires a normal life in the world; indeed, only 
his reentrance into its turmoil and bustle can 
set him surely on his feet. 

The average sanatorium, accustomed to the 
time-honored and thoroughly established sys- 
tem of making its patients comfortable, — in 
other words, pampering and coddling them, — . 
finds it difficult, if not impossible, to conform in 
every detail to the necessities of a system like 
mine. 

Even if the institution is equipped with every 
possible facility, it is highly probable that the 
physicians in charge may be mentally unfitted 
to the work. Inured by every detail of their 
training to methods that make a successful 
treatment of drugs impossible, they find them- 
selves incapable of changing when confronted 
by specific cases that demand a radically differ- 



176 HABITS THAT HANDICAP 

ent treatment, The institutions thenis-" bs : i e 
equally inadaptable. The sanatorium, it mnst 
be remembered, is really a boarding-house or 
hotel, and the business of boarding-house or 
hotel, whether it presents an epicurean or "sani- 
tary ' ' bill of fare, or whether its staff is supple- 
mented by trained nurses and physicians or not, 
remains a boarding-house or hotel Its main 
province is to keep its paying guests and : 
make them comfortable. 

The whole sanatorium situation so far as if 
relates to the f i cure ' ' of those addicted to the n b b 
of drugs and alcohol may be summed up in a 
few words. The average sanatorium is merely 
a small colony of drug-user-. Xo one can deny 
that. Now, no man who has been freed from 
his desire for drugs and no one who is being 
made uncomfortable by deprivation will remain 
in such surroundings for any length of time. 
The natural conclusion is that such institutions 
are not accomplishing what they have promis e 3 
to be able to accomplish. The inmates are still 
drug-users. This is not true of American insti- 
tutions alone. Within a few months I have had 
as an eleven-day inmate of my own institution 
a very wealthy man who has made three Euro- 
r_ ean journeys to find relief from the drug habit, 



THE SANATORIUM 177 

on each journey going the rounds of six or eight 
celebrated institutions, and taking the treatment 
of each without result. Successful treatment is 
brief treatment, and no establishment operating 
upon a system of a weekly charge to patients 
will make an earnest effort to release these pa- 
tients as soon as possible. In their desire to 
make their patients comfortable, and so prolong 
their stay, their usual quantity of drugs is sup- 
plied to them, though of course in some dis- 
guised form. There is no other way of accom- 
plishing this. 

Moreover, so long as a patient is thus kept 
comfortable, he is unable to describe his symp- 
toms, for he does not feel them. The drug, 
therefore, hides exactly those details of a man's 
condition that it is essential for the attending 
physician to know. In a normal man the pres- 
ence of pain is always a guide for a physician, 
but in a drugged case this is always absent. 
The constant drugging that conceals the symp- 
toms of organic ailment may permit one of com- 
parative insignificance at the time a patient en- 
tered a sanatorium to become incurable before 
he leaves. Thus the result of his stay may 
mean in the end a serious or even fatal deteri- 
oration. 



178 HABITS THAT HANDICAP 

And the prolonged stay becomes a means, in- 
tentional or unintentional, of mulcting the pa- 
tient or his friends of money. The snm an- 
nually spent in the United States upon useless 
sanatorium treatment must certainly amount to 
millions. I have had patients come to me from 
such institutions to which they had paid sums 
as large as $10,000. Wealthy people are spe- 
ciallv likelv to become victims of this form of 
rapacity, and a mere glance at some of the re- 
ceipted bills that I have seen in their possession 
is enough to stagger a modest financial imagina- 
tion. The ingenuity with which a sanatorium 
manager devises " extras" is worthy of the 
name of genius. And the physically incurable 
patient is often retained in the sanatorium till 
his money or the money of his friends is ex- 
hausted in a needless sacrifice to greed. 

THE PHYSICIAX 's ATTITUDE TOWAED THE DETTG-TTSEE 

It is also necessary to direct attention to some 
of the errors of the general medical practitioner 
who deals with cases of this sort. It is not un- 
natural for a doctor to hesitate at the thought 
of surrendering his patient into strange hands. 
There may be unselfish as well as purely mer- 
cenary reasons for this hesitation. The doctor 



THE SANATORIUM 179 

may hope that he himself can aid the sufferer, 
and may therefore endeavor to administer this 
treatment either in the patient's home or possi- 
bly in his own residence or private hospital. 
The patient is likely to be as much inclined to 
this course as the doctor, for the doctor is his 
friend and confidant, and he dislikes intensely 
the idea of revealing what he regards as the 
shameful secret of his enslaved soul to stran- 
gers' ears. Treatment in the doctor's or the 
patient's own environment must of necessity be 
an expensive matter, but if the patient can 
afford it, he is likely to desire it. This is most 
natural, especially if the patient is one of the 
tens of thousands who have tried the treatment 
offered by a sanatorium and found it not only 
valueless, but horrifying. There are, too, many 
patients who from sheer lack of funds naturally 
desire a home administration of the treatment 
as a means of saving expense. Of course many 
of the most worthy cases are to be found among 
people of moderate or small -means. The drug 
habit is itself impoverishing. 

Even so I find myself irresistibly impelled to 
advise against any attempt to treat such cases 
in their own environment, or in any environ- 
ment improvised by a local doctor. This I do 



180 HABITS THAT HANDICAP 

only because I have known so many cases of 
utter failure, so many cases where the suf- 
ferer's final hope has been destroyed by such 
experiments. 

PKIVATE ADMINISTRATION OF TREATMENT NOT 
STJCCESSEUL 

The friendship existing between a physician 
and his patient must often disarm the former 
and incapacitate him for the strict dealing that 
is required in a treatment like mine. The mere 
fact that in caring for a friend or one of his reg- 
ular patients the doctor feels unwilling to exact 
a definite charge in advance is a certain handi- 
cap here, as is also the fact that each patient 
needs continual watching, and no doctor can af- 
ford to devote his entire time and constant med- 
ical attention to one patient. The average doc- 
tor in private practice, moreover, finds it impos- 
sible to secure upon demand nurses of sufficient 
moral responsibility and medical assistants of 
sufficient technical training to cooperate with 
him in the work. Above all, I find that only 
when the patient is on premises other than his 
own, in unfamiliar surroundings where he is 
subject to a strict and inviolable discipline, can 
the best results be obtained. The doctor who 



THE SANATORIUM 181 

administers this treatment, if he is to win, must 
have every advantage. Hospital surroundings, 
unfamiliar nurses, and strange assistant doc- 
tors are of great value ; but payment in advance 
may be regarded as the most effective means 
for inducing the patient to complete the neces- 
sary, course. An amazing number of people 
have come to me who have confessed that while 
they have from time to time tried other treat- 
ments, they have never completed one of them. 
Others come in a skeptical frame of mind. I 
can mention one such who had been three times 
to Europe, each time on the advice of the very 
doctor who, as the patient was aware, had been 
responsible for his forming the habit. 

No physician in private practice should ever 
attempt to relieve a patient from a drug habit 
in a manner incidental to the conduct of his 
practice, though it is nevertheless true that the 
temptation for doctors to attempt this are ex- 
traordinary. A patient who becomes aware 
that his physician knows of a treatment which 
will bring relief is likely to bring to bear upon 
the physician every possible pressure in the 
effort to induce him to administer it. The doc- 
tor must be liberal indeed who, having made 
such an attempt and failed to achieve good re- 



182 HABITS THAT HANDICAP 

suits with it, will acknowledge that he was mis- 
taken at the start. 

THE NECESSITY OF A FIXED CHABGE FOE TREATMENT 

The advantage of a definite charge, paid in 
advance, was a discovery that I made early in 
my work. With a large proportion of my pa- 
tients it would otherwise have been impossible 
for me to obtain the definite medical result 
which has characterized my work. 

It is quite impossible to make an intelli- 
gently satisfactory mental or physical diagnosis 
of any patient brought to me until he has been 
entirely freed from the drug which he has been 
taking. As soon as this has been fully accom- 
plished, it is possible to consider the case care- 
fully. It is also necessary to make an invari- 
able rule that no person entering my institution 
for treatment shall be permitted to come into 
contact with any other person who is there for 
treatment, for there can be nothing psychologi- 
cally worse than the discussion of symptoms and 
the exchange of experiences among people un- 
der treatment. It is also a rule that in the in- 
stitution physicians employed in the establish- 
ment shall not become intimate with the patients 
or spend with them any time not necessarily de- 



THE SANATORIUM 183 

voted to professional investigation and attend- 
ance. 

Xurses also must be as businesslike as pos- 
sible in all their relationships with patients, and 
must do as little hand-holding and sympathiz- 
ing as possible even in the cases of ultra-nerv- 
ous women patients. It is a principle of the 
average sanatorium to encourage the "sympa- 
thetic" nurse. Wittingly or unwittingly, the 
old-time sanatorium made a practice of manu- 
facturing habitual sanatorium inmates. The 
most hopeless cases I have ever seen have been 
those who have become inured to wearing sana- 
torium stripes. Such will never change their 
tailor till their pocket-book becomes empty. 

Another detail of my treatment not easily 
compassed in the average sanatorium is to con- 
sider every case as an individual case, to be 
dealt with individually. In private practice 
this is often overlooked, and to this I also attri- 
bute many failures in treatment. The individu- 
ality of every case must be borne in mind not 
only throughout the treatment itself, but after- 
ward, during the period of recuperation. The 
case itself is sure to indicate in some measure 
the further treatment which should be followed 
in the period immediately succeeding the pa- 



184 HABITS THAT HANDICAP 

tient's discharge from my institution, and very 
frequently indicates, in fact, the necessity for 
consultation with other specialists and for a 
surgical operation. After the patient has been 
relieved of drugs comes the time to begin the 
necessary physical upbuilding by means of ex- 
ercise. Although I may have seemed to con- 
demn the sanatorium, I must add now that some 
institutions are specially qualified to assist in 
this building-up process. Some health-building 
institutions that devote their entire attention to 
strengthening their patients by means of phys- 
ical exercise are doing wonderfully good work. 
The fact that my methods in treating these 
cases have prevented me, and will prevent me, 
from becoming directly or indirectly interested 
in any institution other than my own, in New 
York City, gives me a freedom in offering ad- 
vice to patients concerning what they should do 
after they have left my care that I should not 
feel if my institution were operated upon the 
old-time keep-them-as-long-as-you-can plan. I 
find it possible to suggest physical exercise and 
even professional training to those who espe- 
cially need it with entire disinterestedness, just 
as I find it possible to suggest to some an in- 
vestigation of some religious influence. 



THE SANATOEIUM 185 

It must be laid down as an axiom that the pa- 
tient must have a mental as well as a physical 
change before the treatment can accomplish all 
the good of which it is capable. Such a mental 
change is highly improbable in the comfortable 
surroundings of the average sanatorium. No 
man or woman ever achieved it by sitting on a 
pleasant veranda in an easy-chair exchanging 
tales of symptoms with other invalids. 

THE REASON FOE THE FIXED CHARGE 

The principal consideration which has influ- 
enced me in shaping my policy of a definite 
charge and limiting the length of stay of my pa- 
tients has been the fact that I find it impossible 
when the effect of the drug has been perfectly 
eliminated to hold most of the patients under 
restraint. The man who has won freedom from 
his habit feels sure of himself ; he desires to get 
away, and he is not afraid to go out into the 
world, where it may be possible for him to get 
the drug again. He will not yield to the temp- 
tation to get it, partly because he will not want 
it, and partly because he knows the horror of 
the habit and does not wish to become involved 
in it again. As a matter of fact, one of 
the hardest tasks I have is that of inducing 



186 HABITS THAT HANDICAP 

people to stay as long with us as we think neces- 
sary, although their prolonged stay means no 
additional payment to us and no additional ex- 
pense to them. 

That is one of the principal arguments 
against colonization ; and it is as much an argu- 
ment against the average municipal or state in- 
stitution as it is against the average sanatorium. 
The theory of colonization in this matter is all 
wrong. 

The question of a definite charge has as much 
influence on my own attitude as on that of the 
patient. From the fact that I know when a pa- 
tient enters my house that I can get no further 
money from him or her beyond the advance pay- 
ment I gain a distinct advantage. I do not feel 
it necessary to cater to my patient's whims, nor 
do I feel it necessary to sacrifice any portion of 
the necessary routine of the treatment because 
the patient may be rich or influential and may 
make extraordinary demands upon me. All 
that I have to do is to go ahead along those lines 
which I know are effective and which will gain 
results. 

The effect of this system is equally admirable 
upon the members of my medical staff, for our 
efforts are devoted not to keeping the patient 



THE SANATORIUM 187 

as long as possible for the purpose of increas- 
ing revenue but to getting rid of him as quickly 
as possible, so that the profit will be relatively 
large. That it is to his advantage as well as 
to mine to see that the treatment is complete 
and effective before the patient leaves is obvi- 
ous. 

These methods take into consideration my 
own and my patient 's psychology. A man who 
deals with this type of patient needs every ad- 
vantage which he can get, for invariably he is 
dealing with abnormalities. 

PHYSICAL DEFECTS REVEALED BY TEEATMENT 

The treatment itself is certain to uncover 
these abnormalities, revealing whether or not 
they are due to physical causes. It becomes 
very quickly evident if there is any real physical 
reason why a patient is not eligible for treat- 
ment, as in the case of an incurable and painful 
physical ailment. No matter how careful and 
frank a patient's statements may be or how 
elaborate the diagnosis that his physician has 
transmitted to me, no matter how elaborately 
careful are the preliminary examinations made 
by my own physician, it is not until the drug has 
been entirely eliminated that we find it possible 



188 HABITS THAT HANDICAP 

to make a really intelligent diagnosis. The 
symptoms of disease, however, are sure to ap- 
pear before the first part of the treatment is 
completed. It is a standard policy of my hos- 
pital at once to inform a patient who has proved 
to be physically ineligible, and to return to him 
his fee. 

This method of procedure has made us care- 
ful before accepting patients to study their his- 
tories, for, naturally, we do not wish to do even 
preliminary work and then return the fee in full. 
We accept no patient for treatment until we are 
provided with a careful and detailed history of 
his case, and it is upon a large collection of such 
histories that I have based many of the theories 
embodied in the subject matter of this book. 
It is especially these detailed histories which 
have enabled me to fix with some accuracy of 
judgment the circumstances leading up to the 
formation of most drug habits. In our invari- 
able practice of returning the fee and discharg- 
ing the patient whom we find ineligible for 
treatment we have surely taken a step in ad- 
vance. There is scarcely an institution of this 
sort in the United States to which a patient 
might write, "I am taking drugs," without re- 
ceiving in reply the invitation, "Come to us, 



THE SANATORIUM 189 

and we will treat you," implying that they will 
give the treatment whether or not an examina- 
tion of the patient shows that he is one who can 
benefit from it. 

THE DUTY OF THE MEDICAL PEOFESSION 

The victim of drugs, whether he is rich or 
poor, old or young, good or bad, deserves the 
public sympathy in a measure scarcely equaled 
by any other class. These folk are sick folk in 
every way I can possibly think of. I am at- 
tempting to see to it that they are protected by 
every safeguard from being victimized. It is 
my hope that through continual and untiring 
education I may force the state medical institu- 
tions throughout the country to assume their 
rightful responsibility in providing proper care 
for drug victims who have slight means or none. 
I purpose to work toward the awakening of the 
medical profession to its responsibility not only 
in regard to the growth of new crops of drug- 
users, but to the care and relief or sequestration 
from medical practice of those among its own 
members whose condition warrants action. 

Perhaps this last step should be the first one 
to be taken. I have given it much thought, and 
can see only one way out of the veritably in- 



190 HABITS THAT HANDICAP 

fernal tangle in which the medical profession 
has enmeshed itself. That would involve a con- 
ference between delegates from the medical so- 
cieties of the various States to form a plan 
whereby the medical profession as a whole or 
in groups might establish and support an in- 
stitution or a number of institutions. These 
should be backed by the most eminent and con- 
scientious men in the profession. They should 
be managed by men fully competent, and should 
be open not only to physicians who need treat- 
ment and are unable to pay for it at a private 
institution, but to all patients, in the certainty 
that there they will receive the proper treat- 
ment, properly administered, and at a reason- 
able charge. I purpose furthermore that every 
institution under private management in the 
United States shall by law be held responsible 
for its methods of treatment. 

LEGISLATION TO REGULATE SANATORIUM^ 

There should be the most drastic legislation 
compelling all physicians and institutions ac- 
cepting this class of patients for treatment to 
report periodically to the board of health which 
has jurisdiction in their district whenever, 
after a three weeks' medical supervision, they 



THE SANATORIUM 191 

still require the administration of habit-forming 
drags. It is only reasonable that any institu- 
tion accepting a patient for this treatment, and 
failing to secure favorable results within a 
period of twenty-one days, should report the 
case to the authorities, giving detailed reasons 
for the failure of the patient to respond to treat- 
ment. 

The general adoption of this rule of pro- 
cedure would mean that a class of unfortunates 
who have never had any protection from any 
source would be immediately provided with defi- 
nite medical help. An accompanying provision 
would insist that patients who for physical 
reasons are found to be ineligible for treatment 
— unable, that is, to exist in comfort without 
regular doses of their drug — will be relieved of 
all sense of disgrace arising from this necessity, 
and will be preserved from victimization, and 
will find it possible to get the drug without diffi- 
culty and at reasonable prices, if necessary, 
from the boards of health themselves. If this 
plan accomplished nothing more than to pre- 
vent the operation of medical fraud against suf- 
ferers for a period longer than three weeks, it 
would even then have accomplished an extraor- 
dinary good. 



192 HABITS THAT HANDICAP 

I have in my present hospital only fifty beds, 
and as a rule I receive and discharge about four 
patients a day. Were my institution operated 
along the colonization lines which are common 
in the United States, the volume of business 
which I handle in a year, running well above a 
thousand patients, would require not fifty, but at 
least five hundred beds, and rooms in propor- 
tion. This statement of the exact situation in 
my own institution may possibly explain exist- 
ing conditions in some others. 

It must not be understood that I attribute all 
the efforts at colonizing drug-users to un- 
worthy motives. Much of it has been due to the 
complete ignorance of the medical profession 
in regard to this form of affliction. Finding it- 
self unable intelligently to cope with conditions, 
it seeks the line of least resistance and adopts 
the colonizing sanatorium, with all its evils, as 
the best plan that can be found. When I first 
took up this work I went for information and 
assistance not to the humble members of the 
medical profession, but to the most eminent men 
whom I could find. Even these men invariably 
admitted their ignorance of the nature of the 
drug habit and the means for its relief. I was 
told by some of the best-known neurologists in 



THE SANATORIUM 193 

the world that out of thousands of patients 
whom they and their confreres had sent to the 
best-known and most conscientiously operated 
institutions in the country not one had really 
been helped. They assured me that if I had 
found something which would give actual and 
material aid in any degree to even five per cent, 
of the drug victims who were sent to me for 
treatment, I would be doing more than any man 
had ever done before. 



CHAPTER XI 

PREVENTIVE MEASURES FOR THE DRUG EVIL 

EARLY in my investigations into the proper 
facilities for the medical treatment of 
drug-users it became apparent that this could 
not be properly carried out in the patient's own 
environment, in a general hospital where new 
facilities had not been introduced, or in the 
usual sanatorium. It became necessary for me 
then to outline some system by which the med- 
ical profession might properly take up the work 
and to suggest some basis on which the medical 
men of various States might combine in an ef- 
fort to remove the treatment of these sufferers 
from the hands of the irresponsible. 

Some, if not the majority, of the worthiest 
subjects of the drug habit are people who can- 
not pay large sums or travel long distances in 
their search for relief. It seemed clear, there- 
fore, that state institutions should be equipped 
with facilities and knowledge for dealing with 
this affliction. 

194 



PKEVENTIVB MEASURES 195 

THE NEED FOR PRACTICAL INSTRUCTION 

At the present time there is in existence no 
clinic or other practical place of demonstration 
where a doctor can get competent instruction in 
this important branch of medical work. I hope 
the time will come when it may be possible for 
me to offer to the medical profession a clinic 
where the professional student may prepare for 
this line of effort as effectively as he may now 
prepare himself for any special work, like nose 
and throat diseases. This can come about only 
through some arrangement in which I have no 
financial interest. 

SKEPTICISM OF THE MEDICAL PROFESSION 

I am fully aware that I must first overcome a 
strong undercurrent of skepticism among the 
members of the medical profession. The effi- 
cacy of the treatment must be proved. Even 
among the best-informed physicians it is a pop- 
ular belief that the treatment which I announce 
as simple is really an impossibility. No matter 
what the doctor has hoped that he might do, he 
has been told by text-books and articles in med- 
ical periodicals that it cannot be done. This 
fallacious teaching must be counteracted before 



196 HABITS THAT HANDICAP 

much can be accomplished, and in the progress 
of the work many traditions of the profession 
must be violated. Before he can hope to ac- 
complish anything of importance in the admin- 
istration of my method of treatment, the physi- 
cian must understand that the length of time a 
drug-user has been taking the drug, the quantity 
that he has taken, and the manner of its admin- 
istration are matters of no consequence. Short 
histories and small amounts, long histories and 
large amounts, are all one when it comes to 
the administration of this treatment. I went to 
Dr. Eichard C. Cabot of Boston with a letter of 
introduction from Dr. Alexander Lambert of 
Xew York, whom he knew well and admired. 
He listened to my statement of the facts which 
I have just set forth. 

' 'I have heard what you say, but I shall not 
believe it until it has been demonstrated to me," 
he declared. 

I demonstrated it, and convinced him. A 
similar skepticism remains general throughout 
the medical profession. 

The experience that the medical profession 
has already had in Xew York State as the result 
of prohibitive legislation indicates the many 
problems that arise immediately after the drug 



PREVENTIVE MEASURES 197 

is put beyond the reach of those who have ac- 
quired the habit. It is only natural that the un- 
scrupulous should seek to take advantage of the 
opportunities created by this situation. With- 
out proper treatment, an habitual drug-user 
cannot endure the agony of deprivation until a 
definite physiological change has occurred; so 
that unless the medical profession is informed 
of this fact, and the community at large is pro- 
vided with facilities for the administration of 
the required treatment, it is almost inevitable 
that restrictive measures will be followed imme- 
diately by the victimization of the unfortunate 
by the unscrupulous. One detail of the peril to 
society which may accrue from a general cessa- 
tion of the drug traffic without the provision of 
proper facilities for the care of those who have 
been its victims is that those who are accus- 
tomed to drugs, on being suddenly deprived of 
them, almost invariably turn to alcohol for 
stimulation and, without being the least re- 
lieved of the drug habit, with abnormal speed 
become alcoholics. Modern society presents few 
spectacles of suffering more acute than that en- 
dured by the drunken drug-fiend. Few per- 
sons, moreover, are so dangerous to its wel- 
fare. 



198 HABITS THAT HANDICAP 

MEDICAL ETHICS 

Constantly I must lay emphasis upon the re- 
sponsibility of the physician in regard to drug 
habits. This phase of the subject must be an 
ever-recurring one, because the whole unpleas- 
ant situation has grown out of medical igno- 
rance. While treatment for drug-users is at 
last making headway, for a long time experi- 
mentation had no chance save with a small num- 
ber of broad-minded and bright-minded doctors 
who were able to shake off the shackles that held 
the less intelligent members of their profession. 

TThen I made public the formulas of my treat- 
ment, I did not understand this phase of medical 
ethics. I assumed that certain dangers might 
arise from the probable activities of the omni- 
present medical faker, who without any genuine 
effort to administer my treatment properly 
would advertise it widely, and thus victimize the 
innocent. I also assumed that the medical pro- 
fession would eagerly grasp the idea, put the 
treatment into operation, to their own benefit 
and that of the world at large, and by the very 
beneficence of their work far more than offset 
the harm the charlatans would do. 

Both of these assumptions proved incorrect. 



PREVENTIVE MEASURES 199 

The fakers avoided even counterfeiting my 
treatment, because the articles which had an- 
nounced it in the medical and lay press had 
made its brevity clear to the public ; they did not 
care to promote any treatment in which their 
victims would be justified in demanding immedi- 
ate_ relief. From that real peril the community 
was thus saved. But the general indifference 
of the medical profession was equally surpris- 
ing and at first somewhat discouraging. I have 
since decided, however, that this was perhaps 
fortunate ; for as the work develops, it becomes 
more and more apparent that it is a strictly hos- 
pital treatment, and cannot often be successfully 
administered in the environment of the home or 
in the regular course of a general practitioner's 
daily work. 

In another part of this book I shall have more 
to say about the medical buzzards who, working 
outside of medical ethics and in defiance of the 
usually admirable spirit of the profession as a 
whole, without regard to financial or ethical 
honesty, indulge in whatever practices seem to 
promise them the greatest profit. How danger- 
out these men are not only to the patient, but to 
the profession has many times been illustrated. 
Various medical discoveries imported from 



200 HABITS THAT HANDICAP 

abroad or achieved and announced by eminent 
American medical men have brought flocks of un- 
scrupulous practitioners to New York, not with 
the progressive desire to study and honestly ap- 
ply these new theories for the benefit of their 
patients, but with the idea of learning barely 
enough about them to enable them to offer 
credulous sufferers cheap and worthless coun- 
terfeits at exorbitant rates. "Where secret 
methods have been heralded, they have bid 
against one another frantically to secure lo- 
cality privileges, working to this end with all 
the fierce competitive enthusiasm shown by 
eager commercialists seeking county rights to a 
practical and popular patent flat-iron. It is my 
earnest hope that the wave of reform which has 
begun in New York State, and which undoubt- 
edly will carry new and effective drug legisla- 
tion into every State of the Union before it loses 
its forward impulse, may not revitalize these 
unworthy schemers. It was partly the hope of 
preventing this evil that led to the writing of 
this book. 

The progress of intelligent legislation will fill 
the land with much suffering from the tortures 
of drug deprivation. Therefore events have 
placed a solemn obligation upon the medical pro- 



PREVENTIVE MEASURES 201 

fession to satisfy itself of the efficacy of my 
treatment, even though a new organization for 
that purpose should be necessary. After the 
profession is assured of the value of the treat- 
ment, many should achieve competence in its ad- 
ministration. Then it will become a matter of 
duty to see that every community is provided 
with facilities and a staff of experts sufficient to 
meet the special needs that may arise there. 
If such an organization should be formed, I 
should be glad to devote my services to it. 

THE AUTHOR'S EXPERIENCE WITH THE 
DRUG HABIT 

My opportunities for observation in this field 
have extended over fourteen years of constant 
study. They have included investigations in 
the Orient and Europe as well as in the United 
States, and have dealt with patients of every 
class. Early in my work I found it difficult to 
secure subjects, and presently saw that I 
could do so only by personally searching the un- 
der-world for them. 

It was a complicated task, full of unexpected 
problems. As I could not engage salaried 
people for the carrying out of the details of the 
treatment, it became necessary for me to do 



202 HABITS THAT HANDICAP 

everything except the medical work, and to as- 
sume all except the medical responsibility. 
But what I at first deemed a hardship proved in 
the end to be an advantage, for if I had had 
plenty of money with which to carry on my 
work, I should never have mastered its details. 

It may be that the need for making the work 
strictly self-supporting from the start led to one 
of my first important psychological discoveries : 
that any person worth saving is either able to 
pay a reasonable amount for treatment or can 
make the price of it a deferred obligation of 
such a character that it will certainly be met. 
The experience from which this and other state- 
ments in this book have been deduced is not an 
experience gained from casual or even regular 
daily calls of a few minutes or a few hours upon 
the patients under treatment, but is due to years 
in which I have frequently spent twenty-two 
hours out of every twenty-four in the same 
building with them, and subject to their con- 
stant call. 

After having proved the efficacy of treatment 
at home it seemed advisable to make a journey 
to the Orient, where drug habits were notori- 
ously more common than elsewhere. It was the 



PEEVENTIVE MEASURES 203 

desire to study them at first hand and literally 
by wholesale which led me to China, where I 
opened three hospitals, and in the course of 
eleven months supervised the treatment for the 
opium habit of over four thousand Chinese. 
During this period I treated all who presented 
themselves, the ages of those to whom relief 
was given ranging from eighteen to seventy-six. 
Among the four thousand patients not one fa- 
tality occurred, although many of them were ex- 
treme cases, and I was able to obtain the assist- 
ance of only one foreign physician who could 
be considered responsible. The rest of the 
work was done by untrained Chinese boys, who 
administered the capsules at stated hours, and 
not one of whom was capable of intelligently 
counting a patient's pulse. 

I have said that not one fatality occurred. It 
is pleasant for me to add that during the whole 
fourteen years of my practice, although I have 
had thousands under treatment, many of them 
in exceedingly bad physical condition at the 
time the treatment was begun, with their drug 
symptoms complicated by various and serious 
physical ailments and often accented by alcohol- 
ism, only four cases have died. 



m4 HABITS THAT HANDICAP 
smmssmo : mmmmimzms m :zz :tsz 

OF DRUG-USEBS 

A ir~ mmmm: aa = mm MMMsari mm 

see »f this sharacter in the course of my hos- 
mm. t~^:;-i:t. For Mr ±rs: mm M~ tr-rat- 
meiif has been reduced to a definite hospital 
sysMM. ommm- ~mm Mr msmm: TM75i:-iai: is 
never divorced z'mm his patient, and ra the 
OMMSr :: ~mm ::iMMr azid olaMraM Mdsidr 
histories and charts are kept. I lave in my 
possession at the present moment the complete 
hedside notes of every patient to whom my 
mm.mmm has mm mm a M" : ^~ : smmj. I :aZ 
attention to this fact hecanse it shows that the 
work has not been hit or miss, but has beM a i 
carefully systematized and made as highly sci- 
entific as it has been possible to make it. 

A second precedent has been set, as is proved 
m Mr fa:: mm m:ml\ ?. "mim mm arv mm m 
drug or alcoholic habit that is not complicated 
M m--:m lis abilities :~m :: :mm mmm :aa 
be successfully treated in a few days without 
heroic methods and without risk. 

This has at once proved the fallacy of old 
immms. I: has ioriMsrratrd m~ false. z:t 
instance, is the principle of colonization. As I 



PREVENTIVE MEASURES 205 

have said, drug cases should never be colonized, 
and among alcoholics only the absolutely hope- 
less inebriate should be subjected to this method 
of treatment. With the latter, of course, there 
is no chance of real relief, so that here coloniza- 
tion offers a means of relieving society of all of 
the-burden upon the police which the inebriate's 
freedom necessarily implies, and from a large 
part of the economic burden which his existence 
entails upon the community. 

MAKING SANATORIUM CONVICTS 

For drug-users colonization is the worst pos- 
sible treatment that can be followed. From 
what I know of the conduct of the average sana- 
torium at this time in the United States, I feel 
absolutely certain that no person could possibly 
be helped if sent there, and I am convinced that 
definite and virtually incalculable harm would 
be the almost inevitable result of following such 
a course. Drug-users, as well as alcoholics, 
who are sent officially or otherwise to institu- 
tions of this character become what are called 
"sanatorium convicts." These cases are vir- 
tually hopeless, and are little less pitiable than 
that of the "lifer" in a prison. There are in 
the United States many people of the better 



206 HABITS THAT HANDICAP 

class who through no fault of their own have 
became afflicted with the drug-habit, and who 
have drifted from bad to worse until a sanator- 
ium has been the only recourse left. 

Treatment for drug and alcoholic habits and 
treatment tending toward the recuperation of 
the patient cannot be carried out together with 
one patient or even simultaneously with sev- 
eral patients in the same institution. An un- 
derstanding of this fact has placed me in an ad- 
vantageous position for giving advice about 
whatever remains to be done when a patient is 
ready to leave my hospital. I have always 
worked in the closest and most perfect harmony 
with physicians who have sent cases to me and 
have never permitted any of the doctors em- 
ployed in my institution to visit a patient who 
has left my care. On the other hand, no physi- 
cian who has brought a patient to my hospital 
has ever been divorced from him as a result of 
his stay with us. 

ACCURATE DIAGNOSIS POSSIBLE AFTER TREATMENT 

Physical revelations which follow the unpois- 
oning of patients frequently startle the patients 
themselves as well as the physicians who have 
their well-being in charge for long periods. 



PREVENTIVE MEASURES 207 

Nor are the mental revelations less astonishing. 
There have been many cases, after the unpoi- 
soning was complete, in which a man or woman 
has been found to be as seriously ailing mentally 
as others have been found ailing physically. 
Drugs and alcohol, especially drugs, have fre- 
quently been responsible for extraordinary men- 
tal and moral twists. But it must be maim 
tained that the use of drug or liquor is usually 
the result rather than the cause of such condi- 
tions. There are many cases in which no type 
of medical help will bring about satisfactory 
permanent results, though other victims, after 
the elimination of alcohol or narcotics, quickly 
take their places as useful and admirable mem- 
bers of society. 

The problem confronting the physiologist 
after a patient has been relieved of a drug or 
drink habit is comparatively simple. If this re- 
lief makes diagnosis possible and reveals the 
existence of an unsuspected, but curable, ail- 
ment, the course to follow is obvious. With the 
psychologist the problem is frequently far more 
complicated. The useless citizen who becomes 
a drug- or drink-user will remain a useless citi- 
zen after the drug or drink habit has been elimi- 
nated. 



208 HABITS THAT HANDICAP 

To this class belong most of those who readily 
relapse into their old habits after their systems 
have been thoroughly cleared of the physiolog- 
ical demand for the substance of their habit. 
Thus perhaps the most important query the psy- 
chologist interested in this work must ask after 
the treatment of a patient is, What is left of 
value, and what can be done with it? It is a 
curious fact that usually more is left in the case 
of a poor than in the case of a rich patient. No 
one is so hopeless as the vagrant rich. No man 
will ever make a reputation in work of this char- 
acter who deals wholly or even principally with 
people to whom money has no value. 

TJNPOISONING THE USER IS ONLY THE FIRST STEP 

My work has brought me to the conclusion 
that few physicians seem able accurately to 
classify their own patients. Even the special- 
ist in psychology, who should be able to weigh 
all the details of men's mental and moral as 
well as physical being, seems likely to go astray 
when he considers a psychology that has been 
affected either by drink or drugs. Many physi- 
cians seem to be imbued with the idea that after 
a patient has once been through the process of 



PREVENTIVE MEASURES 209 

treatment for a drug or drink habit he will be 
entirely made over; but the fact is that the 
elimination of drugs or drink from a degener- 
ate will not eliminate degeneracy. Nothing, in 
fact, will eliminate it except stopping the breed- 
ing of degenerates. 

In my work I have found it necessary some- 
times to seek advice from as many as half a 
dozen physical and psychological specialists in 
connection with one case. While instances have 
been very numerous in which several specialists 
have been really required for the welfare of the 
patient, the need had been so thoroughly con- 
cealed by the patient 's drug habit that it was not 
apparent until the effect of the drugs was thor- 
oughly eliminated. 

NECESSITY FOE CAREFUL PSYCHOLOGICAL STUDY 

In most instances expert treatment for the 
mental condition after drug or drink elimination 
is as essential as expert attention from the doc- 
tor of medicine, and if success is to be achieved, 
must be regarded as an entirely separate task. 
Habitual users of drugs or drink are literally 
human derelicts. The symptoms of their true 
condition are submerged, and to clear them of 



210 HABITS THAT HANDICAP 

their concealed weaknesses it is necessary to 
lift them like a barnacle-ridden hulk into the 
dry-dock for investigation and repair. 

I regard as a preferred risk among the vic- 
tims of the drug habits those who have acquired 
it through the administration of a narcotic by 
physicians in time of pain or illness. Such a 
case, if treated before too great a deterioration 
has taken place, may be considered almost cer- 
tain of relief, provided no other ailment dis- 
closes itself. 

On the other hand, where the drug habit is 
the direct or indirect result of alcoholic dis- 
sipation or sexual excesses, or is a social vice, 
the case is extra-hazardous. Here the lack of 
moral standards and the loss of pride are seri- 
ous handicaps. These matters are of extreme 
importance to the physician who is considering 
the care or treatment of cases of a drug habit. 
That he should classify his subjects of investi- 
gation, recognizing the hopeful ones and ad- 
mitting the hopeless to be hopeless, is essential 
to successful work. He must know the material 
with which he has to work ; familiarity with his 
material is as necessary to him as it is to the 
carpenter. Many cases have been brought to 
us that we have declined to accept because we 



PEEVENTIVE MEASUEES 211 

could hope to accomplish nothing with them. 
Not long after I began my work I tried to help 
a man against my better judgment; I felt rea- 
sonably sure that he lacked the worthy qualities 
that would make him cling to and appreciate 
whatever advantages the treatment might af- 
ford. My estimate of his character proved to 
be correct; the man relapsed, and became a 
traveling liability on me, a reproach against 
my institution and my treatment. 

THE HOPELESS CASE 

I have already said that the idle rich to 
whom money has no value cannot usually be 
classed among hopeful subjects for treatment. 
The same may be said of those for whom 
others take financial responsibility, paying the 
cost of their treatment. If such cases do not 
already belong in the human scrap-heap, this 
mistaken kindness is very likely to place them 
there. 

However, I believe that those among this class 
who have become public charges and refuse to 
work should be forced to do so by state or 
municipal authority. Society or their own fam- 
ilies should not bear the burden of their useless 
existence. They should be segregated in some 



212 HABITS THAT HANDICAP 

place where they will be physically comfortable, 
where they may be made industrious and useful, 
and where a separation of the sexes will prevent 
the increase of their worthless kind. My judg- 
ment is that the man or woman who through the 
vagaries of his or her own disposition has once 
been forced to wear the stripes of disgrace is 
likely to employ the same tailor during the rest 
of his or her life. Such persons will become 
permanent boarders at one or another of the 
places provided for the seclusion of the worth- 
less. It is well that where they are first seques- 
trated there they should be permanently kept. 
Through this course alone society will be spared 
the periodical havoc they will be sure to work 
during their intervals of freedom. 

IMPERSONAL RELATIONS BETWEEN PHYSICIAN AND 
PATIENT NECESSARY 

Certain dangers inevitably arise where an 
intimacy exists between doctor and patient, 
since few physicians are morally so constituted 
that they will order a prosperous patient to do 
this or that or find another physician. In other 
words, instances have not been uncommon where 
the toleration of physicians for unfortunate 
practices among their patients has had its basis, 



PKEVENTIVE MEASURES 213 

and perhaps one not entirely inexcusable in 
these days of high pressure from professional 
competition, in self-interest. Social relations 
also have often led physicians to tolerate prac- 
tices that they knew to be harmful to their 
patients and to the community. A patient who 
is a- member of an influential club or a fashion- 
able church is likely to be an asset of exceptional 
value to the physician whom he patronizes, for 
he is likely to recommend him to his friends. 
Good business management on the physician's 
part leads him to keep such a patient good 
natured and comfortable, and to keep him com- 
fortable means, among other things, to keep him 
free from pain. Where the patient suffers 
from an incurable malady, the use of drugs is 
not only excusable, but commendable; but in- 
stances are all too frequent where the malady is 
not incurable, but only puzzling and beyond the 
average practitioner's power of diagnosis, so 
that he covers up his ignorance by the adminis- 
tration of pain-deadening substances. Patients 
who invariably and promptly pay their bills are 
sometimes in a position where they can tell a 
doctor what to do ; whereas it should be the doc- 
tor 's unalterable resolution to retain the upper 
hand. Instances of this kind are far less grave 



214 HABITS THAT HANDICAP 

in connection with the use of alcohol than in con- 
nection with the use of drugs ; the physician may 
be said almost never to play any part in the 
establishment of an alcoholic habit among his 
patients, while he has surely played a most im- 
portant part in the spread of ding habits. 



CHAPTER XII 

CLASSIFICATION OF HABIT-FORMING DRUGS 

OPIUM is the basis of almost all the habit- 
forming drugs. There is no other drug 
known to the pharmacist that has a similar 
action or can be used as a substitute when a 
definite tolerance of it has been established. 
The chemists have given us more than twenty 
different salts or alkaloids of opium in various 
forms and under as many different trade names, 
and I regret to say that they are busy working 
in their laboratories to put upon the market in- 
jurious drugs under various supposedly harm- 
less disguises, but intended in the end only to 
deceive. 

MORPHINE 

Morphine is the active principle of opium, 
and until a few years ago only crude opium or 
morphine was used for medical requirements. 
Morphine is intrinsically far worse than opium 
itself, for opium has certain properties which 
partly counteract the effect of the morphine 

215 



216 HABITS THAT HANDICAP 

that it contains. But morphine is not only the 
active principle, bnt the actively evil principle, 
of the drag. 

The user of morphine always retains his fac- 
ulties. He is usually capable of intelligent con- 
versation. Unlike the alcoholic's brain, his is 
not inflamed. It is impossible for the physician 
intelligently to discuss his symptoms with an 
alcoholic; with a victim of drugs, on the other 
hand, he can thresh out every detail of the case. 

Later coedine was placed upon the market, 
supposedly an innocent alkaloid of opium, nom 
habit-forming, but still capable of eliminating 
pain and suffering due to illness or injury. 
After taking up this work, my investigations 
soon led me to realize that it was not the quan- 
tity of the drug taken which produced the drug 
habit, but the regularity of the dosage. I also 
found from my clinical comparisons that co- 
deine has only one eighth the strength of mor- 
phine, yet in the end just as surely a producer 
of the drug habit similar to that of morphine 
itself. 

HEEOIN 

At this writing the most harmful form of 
opiate with which we have to deal is heroin. 



HABIT-FORMING DRUGS 217 

This preparation of morphine was first put 
upon the market by German chemists about fif- 
teen years ago, the word "heroin" being noth- 
ing more than a trade name. It was first used 
in cough mixtures, and was widely discussed 
in the medical and pharmaceutical press, where 
it was claimed that all the harm of morphine 
had virtually been eliminated in this product, 
which, without having the depressing effect of 
morphine, at the same time preserved its stim- 
ulating effect. A great number of physicians 
themselves have acquired the habit of taking 
opiates in this form, believing at the outset that 
they were not harmful drugs. 

My investigations soon showed me that heroin 
is three times as strong as morphine in its ac- 
tion, and for that reason its use sets up definite 
tolerance more quickly than any other form of 
opiate. For the same reason it shows more 
quickly a deleterious effect upon the human 
system, the mental, moral and physical deterior- 
ation of its takers being more marked than in 
the case of any other form of opiate. 

Until the Federal Pure Food Law was passed 
we did not know that many of the well-known, 
advertised medical preparations contained 
quantities of various salts or alkaloids of 



218 HABITS THAT HANDICAP 

opium. The unsuspecting users of patent medi- 
cine were making themselves confirmed drug- 
users unwittingly, and did not realize how neces- 
sary the habit had become to them until for one 
reason or another they had been deprived of 
their usual daily dosage. 

The reader may imagine my surprise when, 
although a layman, I found that the physician, 
to whom we had looked for guidance in ad- 
ministering and prescribing these drugs, knew 
nothing about them beyond their physiological 
action; that their medical training both in col- 
lege and in clinics had left them in virtual ig- 
norance of the whole question. The physician 
freely prescribed or administered these vari- 
ous drugs, while laymen were able to buy over 
the counters of druggists prescriptions con- 
taining definite quantities of them. Unknow- 
ingly, the doctor and the druggist were creat- 
ing great numbers of drug-fiends. 

Physicians do not yet know over how long 
a period such drugs can be administered in 
regular daily dosage without setting up a toler- 
ance, after which the patient cannot be de- 
prived of the drug. If the public had been bet- 
ter advised on this subject, it would have been 



HABIT-FORMING DRUGS 219 

able to protect itself, and would have been 
more careful about what it took. 

COCAINE 

Outside the opium group, there is at present 
only one other drug that must be considered as 
habit-forming, and that is cocaine. The prosti- 
tution of this drug from its proper uses is ab- 
solutely inexcusable. It was first used me- 
dicinally about thirty years ago, and as an 
anesthetic only. Its administration upon the 
nose by specialists in that field of surgery soon 
established the fact that it not only deadened 
tissue, but set up a certain stimulation which 
for the time being made one feel abnormally 
strong or mentally active. This was the begin- 
ning of its common use in the shape of so- 
called catarrh cures. Only a small quantity 
— from five to ten per cent. — was used. The 
tissue of the nose is very susceptible to the 
action of drugs. When it is applied in this 
way, the circulation takes up the drug as quickly 
as if taken hypodermically. Unscrupulous 
chemists and physicians have unloaded upon the 
world a drug which is beneficial when taken 
medicinally, but one that has reaped a harvest 



220 HABITS THAT HANDICAP 

of irresponsible victims, in which murder, all 
forms of crime, and mental and moral degen- 
eracy have conspicuously figured, and all for 
financial gain. 

The habit was first generally spread through 
the medium of catarrh-cures. Cocaine con- 
tracts and deadens the tissue with which it 
comes in contact, and thus, as in the case of 
catarrh, relieves the patient from discomfort, 
making him feel, indeed, as if there were no 
nose on his face. Its effect, however, lasts only 
from twenty to thirty minutes. 

This is one of the reasons why the cocaine 
habit is so easily formed. A man taking any 
powerful stimulant is sure to feel a correspond- 
ing depression when the effect of that stimulant 
has died away, and it then becomes necessary 
for him to take more of the drug in order to buoy 
himself up and restore himself to the point of 
normality. It is among cocaine-users, there- 
fore, not a yearning for any abnormally pleas- 
urable sensation which sends them back again 
and again to their dosage, but merely their de- 
sire to be measurably restored to the comfort 
which is natural to the normal state. It must 
be apparent, however, that as soon as it has be- 



HABIT-FORMING DRUGS 221 

corne necessary for any one to resort to the nse 
of a drug in order to rise to the normal there 
has been a marked depreciation, physical or 
mental, and probably both. This explains the 
fact that many criminals are found to be cocaine- 
users. No drug so quickly brings about a men- 
tal and physical deterioration. It is virtually 
certain to be a short cut to one of two public 
institutions, the prison or the madhouse. It 
will send the average person to the prison first 
because it is an expensive drug, and the crav- 
ing for it is more than likely to exhaust his 
financial resources and then drive him to theft. 
It is the most expensive of all drug habits. I 
have known victims who habitually used one 
hundred and twenty grains a day, at a cost of 
about seventy dollars a week. This undoubt- 
edly explains the great number who have been 
made criminals by using cocaine. One who uses 
it thereby diminishes his earning capacity; 
while, on the other hand, one who must have it 
must have money, and much of it. 

It may be that this matter of cost explains 
why the under-world has suddenly taken up 
heroin instead of cocaine. The former is much 
cheaper. 



'222 HABITS THAT HANDICAP 

HYPXOTICS 

While I have only tea:hea nroe the or rare 
group and cocaine. I wish to pnt myself on rec- 
::di:~ as saying that there is no class of drugs 
so sure in the end to bring about a deteriorate: o 
:: the rohysiceh cehag as the eeeei: ese ::' the 
Lyrnoric eee:, or ceai-tar rroah:ts. the sleep- 
i: inducers. I ha~e never en n:re pitiahie 
cases than those who have come to me after they 
had been taking regularly, during a considerable 
period, some cure for sleeplessness. This habit 
not only produces an extreme neurotic condi- 
tion, hut changes the entire temperament of a 
person. It will turn the most beautiful charac- 
ter into an extreme case of moral degener- 
acy. 

nsorama. neanatues. are; c ana antra eats srmm 
from a disorganized physical condition. Try- 
ing to alleviate them by the use of powerful 
drugs does not remove the cause, but componn a 
the physical disabilities which produce these un- 
tortunate rhyshai resaits. >:rae hay I here to 
see as stringent a legal regulation of the sale 
of these drugs, used for this common purpose, as 
there novr is of opium and its products and 
cocaine. 



HABIT-FORMING DRUGS 223 

SLEEPING-POWDERS, OR HYPNOTICS 

The time cannot be far distant when both Fed- 
eral and State governments will recognize the 
danger that lies in the unrestricted sale by drug- 
gists and the uncurbed administration by phy- 
sicians of sleeping-powders, or hypnotics. It 
cannot be denied by any one who is thoroughly 
familiar with the subject of habit-forming drugs 
that in such substances may lie a peril compara- 
ble to that inherent in cocaine and opium com- 
pounds. Hypnotics of many varieties can be 
obtained at any drug store in the United States 
without a doctor's certificate. The sale of bro- 
mides is absolutely unrestricted. The many and 
varied coal-tar products, of which veronal is the 
leader, with trional, suphonal, medinal, as close 
followers, and the numerous proprietary rem- 
edies, such as somnose, neuronidia, bromidia, 
Peacock's bromides, etc., may be mentioned as 
preparations which are widely advertised and 
openly and energetically sold, and all of which 
are definitely dangerous. 

COAL-TAB PRODUCTS 

Preparations for headaches and neuralgia are 
notably dangerous. There can be no doubt of 



224 HABITS THAT HANDICAP 

the necessity for legal restriction of the sale of 
anti-kanmia, phenalgin, orangeine, Koehler's 
headache remedy, shac, all coal-tar products 
notable for their production of anemia and 
depression, and undoubtedly responsible for 
the presence of many men and women in the 
mad-houses of the land. The chemist whose 
genius is responsible for the introduction of 
caffeine to overcome the depressing effect of 
some of the other component parts of these prep- 
arations has put hundreds of thousands of dol- 
lars into the pockets of the manufacturing drug- 
gists and has saddled the world with a great 
and unnecessary weight of physical and mental 
degeneration. 

THE PERIL OF THE DRUG-STORE 

Not least among these preparations that have 
most importantly contributed to the tragic army 
of drug-users in the United States have been 
various diarrhea remedies and other bowel cor- 
rectives containing a large amount of straight 
opium. Morphine, opium, and heroin appear in 
many cough-mixtures in habit-forming quanti- 
ties and are offered for sale everywhere save 
in New York State, where recent legislation 
somewhat restricts the traffic. Indeed, in every 



HABIT-FORMING DRUGS 225 

State except New York there are few druggists 
who do not make up and sell preparations of 
their own containing codeine, morphine, heroin, 
or some of the derivatives of opium. 

No druggist has a right to prescribe any of 
these powerful drugs. The American public 
has fallen into the bad habit of trusting the drug- 
gist when it should go to the physician. A 
dozen times every day in the experience of the 
average American druggist a customer enters 
who says, "I want something to make me sleep/ ' 
or, "I want something to cure my headache." 
Without hesitation, and without blame, for with 
him the custom has probably been unconsciously 
built up, the druggist reaches to his shelf and 
dispenses preparations in which the utmost peril 
lurks — preparations containing ingredients 
which should be sold only on the prescription 
of a physician. Under the present law, as I 
think it exists in every State, druggists cannot 
prescribe, but they can advise customers to pur- 
chase advertised preparations and those which 
they themselves compound. 

Only a very powerful drug can stop a head- 
ache as quickly and completely as Americans 
have come to demand. The preparation must 
be strong enough to deaden disordered nerves, 



226 HABITS THAT HANDICAP 

and being chosen because it will be generally 
effective, not selectively effective, as in the case 
of a remedy chosen after an intelligent diagnosis 
has revealed the nature of the trouble to be 
treated, it is virtually certain to have no cura- 
tive qualities whatever. Hundreds of deaths 
have resulted from unwisely experimenting with 
such preparations. Most of us have peculiar 
idiosyncrasies with regard to certain drugs. I 
have seen patients who could not take so much 
as two grains of veronal or trional without flush- 
ing, itching, and similar symptoms. With such 
people large doses might bring about serious 
results and even death. 



CHAPTER XIII 

PSYCHOLOGY OF ADDICTION 

THE common idea that one who is struggling 
with a drug or alcohol habit needs sym- 
pathy and psychological encouragement is to- 
tally at variance with the facts. No one has 
ever accomplished anything worth while by 
holding the hand of an alcoholic, and any one 
who is endeavoring to help a case of this sort 
will find himself instantly and seriously handi- 
capped if he puts himself in intimate personal 
relationship with his patient. Social inter- 
course in any degree should be tabooed. The 
physician should never take a meal with any of 
his patients, or visit a theater with them, or take 
a drive with them. I have never made a friend 
of one of my patients, although among them 
have been many whom I should be glad to num- 
ber among my friends; and no man would go 
further to help them than I. 

Personally, I have never been an excessive 
alcoholic. It is an interesting fact that many 

227 



228 HABITS THAT HANDICAP 

men endeavoring to deal with people of this class 
use as a bait the statement that they themselves 
have been victims. Their usual claim is that 
they first cured themselves, and then took up the 
work of curing others. I remember a meeting 
of social-service workers in Boston that I was 
invited to address. I made a statement to this 
effect in the course of my talk and greatly of- 
fended a previous speaker who had emitted the 
usual professional patter concerning his original 
self -cure. I was quite willing to compare with 
him the results of our methods of treatment, but 
had no opportunity so to do. 

HEKEDITAKY TENDENCIES TOWAKD ADDICTION 
AN IMPOSSIBILITY 

It is absolutely essential that the man who 
wishes to help another who has lost control must 
first accurately understand not only his mental 
imperfection, if there is any, but his general 
psychological state. The line between sobriety 
and drunkenness in the man who has once lost 
control is almost indistinguishable ; it is impos- 
sible when talking with him to be sure whether 
you are talking with the normal mind or with 
the alcoholic mind. Having once made certain 
that it is the normal mind to which you are pre- 



PSYCHOLOGY OF ADDICTION 229 

senting your arguments, your next necessary 
step is to strip away every mental reservation. 
Thousands of men who have honestly desired to 
leave off alcohol have been prevented from doing 
so by their own secretiveness ; it is this mental 
reservation which has been responsible for many 
of the failures of my treatment. 

While the absolute inheritance of a craving for 
alcohol is, in my experience, a rare thing — so rare 
as to seem almost negligible, there is no doubt, 
on the other hand, that many men and women 
inherit imperfect nervous systems. An imper- 
fect nervous system, if it knew the reason for 
its own imperfections, might naturally crave al- 
cohol ; but inasmuch as such an imperfect system 
is not naturally accompanied by this instinctive 
knowledge, the theory of hereditary alcoholic 
craving must be set aside as untenable. I abso- 
lutely deny, therefore, the possibility of such 
hereditary tendencies. I know that by so doing 
I may cause acute mental discomfort to those 
who have made of heredity an excuse for their 
errors not only to their friends, but in their own 
minds. The old cloak of heredity has been worn 
to tatters and must be discarded. Who among 
us cannot follow up the branches of his family- 
tree and find somewhere upon one side or the 



230 HABITS THAT HANDICAP 

other a person of alcoholic tendencies? In 
ninety families out of a hundred any one who 
looks can find such an excuse for his own weak- 
ness. In thousands of instances physicians 
have taken seriously such excuses offered hy 
their patients, but the doctor who listens to his 
patient's babble of heredity is sure to be misled, 
and the patient who believes this too commonly 
accepted theory robs himself of his strongest 
weapon against alcohol — his own conviction of 
his personal responsibility and power for self- 
help. 

ALCOHOLISM AS A DISEASE 

We hear much sympathetic talk of the "dis- 
ease of alcoholism. ' ' This is only in a sense 
true. It is not a case of helpless chance, for the 
difficulty has been manufactured and developed 
by man himself. The alcoholic, mentally weak- 
ened by the reaction of the stimulant, is of all 
people most likely to exhibit that most striking 
evidence of weakness — a craving for sympathy 
rather than for blame. Habitual alcoholics con- 
tinually plead for sympathy with mothers, fa- 
thers, wives, and friends ; and too often they are 
granted not only pity, but, what is worse, tolera- 
tion. The sanatorium promoters and proprie- 



PSYCHOLOGY OF ADDICTION 231 

tors of fake cures continually harp on alcoholism 
as a disease; and even a few scientists, who 
should know better, have been misled into an ac- 
ceptance of this theory. Doctors should be the 
first to knock from under their patients the psy- 
chologically harmful props of the heredity theo- 
ries.. 

The first thing a physician must do when deal- 
ing with an alcoholic is to cut every string of 
excuse which lies between him and his habit. 
He must leave nothing of this sort to which the 
drinker may cling. Sickness, worry, unhappy 
circumstances of whatever sort must immedi- 
ately be eliminated as excuses for alcoholic in- 
dulgence. If they are not, the patient, although 
he may gain for a time the mastery over his 
habit, will presently be certain to find an excuse 
in his own mind to justify a return to it. Then 
will come a new downfall. There must be no 
reservations either in the attitude of the doctor 
or his patient or in the mental attitude of the 
patient toward himself. 

MENTAL ATTITUDE A VITAL CONSIDEKATION 

The possibilities of medical help for the alco- 
holic have been exhausted when the patient has 
been freed from the effect of the stimulant and 



232 HABITS THAT HANDICAP 

put in a physical condition wherein he feels no 
inclination toward more alcohol. Great psycho- 
logical assistance may accompany this definite 
medical treatment when the patient's physical 
craving for alcohol has once been eliminated if 
the physician brings him into a mental state 
which gives him confidence in his own ability to 
keep away from stimulants in the future. 

I cannot too strongly emphasize the fact that 
no cure exists, or ever will exist, for alcoholism. 
Its effects may be eliminated, and the victim's 
physical condition become so greatly improved 
that weakness will not make him yearn for stim- 
ulation; but this does not constitute a cure. 
Nothing except a man's own mind, whether the 
treatment extends over six weeks, six months, or 
six years, can ever relieve him of the danger of 
a relapse into alcoholism. In most cases a defi- 
nite medical treatment is the intelligent begin- 
ning of help, but no medical treatment, no mat- 
ter how successful, can compass that victory 
which a man must win by means of his own de- 
termination. 

THE CHEONIC ALCOHOLIC 

The physician still regards such cases only 
from the point of view of physical hazard. It 



PSYCHOLOGY OF ADDICTION 233 

is my opinion that in alcoholic cases the physical 
hazard is the matter of least importance, and 
that the world at large has devoted altogether 
too much effort to its endeavors to preserve 
chronic alcoholics, just as it has devoted far too 
little effort to rescue the victims of drugs. It 
is my opinion that among alcoholics, no matter 
how worthy they may have been before they lost 
control, not more than twenty-five per cent, of 
those whose addiction has become chronic are 
curable; that is to say, promise any reward 
whatever for salvage work. The world must 
remember that the inflamed brain leads to every- 
thing on earth which is not worth while, and 
therefore that the man whose brain has for any 
considerable period of time been in this condi- 
tion must have enormously deteriorated. It 
must also be remembered that at least one half 
of the world's chronic alcoholics have syphilitic 
histories. 

The alcoholic is usually susceptible to the ad- 
vances of any woman whatsoever, and as a rule 
devotes less than the normal attention to his 
own wife. To set out to reclaim a chronic alco- 
holic is, therefore, to set out to reform a man 
who has been weakened morally and mentally as 
well as physically. In dealing with such people, 



234 HABITS THAT HANDICAP 

were the matter left entirely to me, drastic meas- 
ures would be taken. It is my belief that the 
hopeless inebriate should be unsexed, not be- 
cause of the danger that, if left sexually normal, 
he might transmit his alcoholic tendencies by 
heredity to his offspring, but because he is a lia- 
bility at best, and to leave him normal adds to 
his potentiality for waste and evil. Children 
born of alcoholic-tainted parentage are not 
specially likely, I think, to yield to alcoholic 
and tobacco tendencies; but they are apt to 
lack vitality and mental stamina, so that the 
probability of their making worthy records is 
small. If we go one step beyond syphilis and 
consider other venereal diseases, we shall un- 
doubtedly discover that not twenty-five, but 
ninety, per cent, of chronic alcoholics, excluding 
women, have been victims of gonorrhoea. I am 
told that modern science is recognizing this dis- 
ease, which was once regarded as of slight im- 
portance, an inevitable experience of youth, and 
something to be accepted and regarded lightly, 
as an ailment of nearly as vicious an influence 
upon the race as is syphilis. Therefore I have 
become convinced that the salvage of alcoholic 
derelicts is of vastly less importance than pre- 
vention at the outset. This principle is being 



PSYCHOLOGY OF ADDICTION 235 

more and more generally recognized throughout 
the world; it stands behind sanitation and all 
preventive medicine, and it will before long be 
recognized in connection with the problem of 
alcohol. Thus the battle against alcohol will be- 
come, as the battle against tuberculosis has be- 
come, a campaign of education. 

It is my belief that every community should 
have an institution in which hopeless inebriates 
may be kept away from their cups and away 
from sexual association. There they should be 
put at useful occupations ; full advantage should 
be taken of whatever productive capacity alcohol 
may have left in them ; and they should be main- 
tained in a state as happy as their capabilities 
may permit until they mercifully die. Their 
segregation would not prevent hereditary 
drunkenness, for there is, as I have said, no 
such thing as an hereditary drunkard, but it 
would prevent the transmission of imperfect 
nervous systems, and depleted intellect and will 
power. 

SELF-CONFIDENCE NECESSARY 

Involved in helping these cases, my investiga- 
tions have shown me that when once it is deter- 
mined on reasonable evidence that a man is 



236 HABITS THAT HANDICAP 

curable, the first effort should be devoted to 
reestablishing his confidence in himself. He 
should be "given a new mind" upon the sub- 
ject of drink and general self-indulgence. It 
does little good to free a man from alcohol if 
his mental state is so poor that he will celebrate 
this boon by again making himself a voluntary 
victim of the habit. It is for this reason that I 
have found the least hopeful work in reclamation 
to be that which is conducted among the idle 
rich. The alcoholic idle poor are virtually hope- 
less ; the alcoholic idle rich are absolutely hope- 
less. To the reform of the drunkard mental 
and physical occupation and some sense of moral 
responsibility are imperative. It is because of 
these things that I have deliberately and per- 
sistently refused to use the word "cure" in con- 
nection with my treatment. A man cannot be 
cured of alcoholism. He can be given medical 
aid which will restore his self-control. 

The ordinary methods in vogue for the recla- 
mation of alcoholics are pitifully futile. The 
greatest mistake of all is that workers never fin- 
ish with those whom they are endeavoring to 
help. One must finish with the alcoholic 
promptly and conclusively. I have found that 
alcoholics taking treatment at my hospital must 



PSYCHOLOGY OF ADDICTION 237 

understand that I do not wish to hear from them 
after they have left my care ; that I do not wish 
to know if they have yielded to new madnesses 
and relapsed into alcoholism. It is specially im- 
portant for an alcoholic to learn that at a certain 
point society will have had enough of him. Fa- 
thers must break with alcoholic sons and daugh- 
ters, mothers must break with alcoholic children, 
wives and husbands must be freed from alco- 
holic mates, charitable institutions must be rid 
of alcoholic derelicts. Society itself must be 
rid of this waste material, after it has ascer- 
tained that their cases are hopeless and has pro- 
vided comfortable sequestration for them. 

THE DKUNKAKD WHO CAN BE SAVED 

Now let us turn to the vast army of people 
who are worth while, but who, nevertheless, 
have, through mistakes common to our society, 
become victims of the alcoholic habit. It would 
almost seem that the incurables among alcoholics 
have received more consideration from the 
kindly minded, and even from the scientifically 
inclined, than have the curable s. The curable 
among alcoholics are intense and pitiable suf- 
ferers. They have never had real help. They 
have been penalized. The poor among them 



238 HABITS THAT HANDICAP 

have been colonized in harmful state institu- 
tions by the public authorities ; the rich among 
them have been placed in equally harmful pri- 
vate institutions by their relatives and friends. 
The alcoholic who is punished by incarceration 
in a cell is harmed, not helped, by it; the man 
who, on the mythical chance of reform is shunted 
off to a state establishment, or who is sent 
by prosperous friends to board at some 
expensive sanatorium, stands to lose, not gain, 
by his experience. These methods merely 
beg the question. They recognize the drunk- 
ard as a liability and put him out of sight; 
they do nothing toward his real regeneration. 
The inebriates ' farm is based on the same utter 
misconception as the fashionable sanatorium to 
which the rich man's son may be committed. 
An intelligent handling of this subject would 
close or entirely reform ninety -nine per cent, of 
the public institutions devoted to the care of 
inebriates, and would depopulate one half of the 
sanatoriums between the Atlantic and the Pa- 
cific. To put a poor man to sober up on a farm 
where the State will pay his board and expect 
him not to become an active menace to society as 
soon as the period of his sequestration comes to 
an end is no more foolish than to put the rich 



PSYCHOLOGY OF ADDICTION 239 

man's son into a private institution where he 
will be petted, coddled, and retained at the high- 
est rates as long as possible, and from which 
he will be eventually permitted to return to his 
old haunts freed from the immediate physical 
discomforts of his past alcoholism and therefore 
provided with a fresh capacity for strong drink 
and "rejuvenated powers for evil-doing. Placing 
a drunken young man in a sanatorium where 
some one will pay his board while he lives in 
utter idleness is certain not to correct, but to 
complete, the evil work which has been started 
in him ; and thus in many cases the very means 
adopted by friends and parents for the benefit 
of those they love are likely to increase rather 
than to decrease their ultimate tendency toward 
dissipation. 

Nothing can be much more pitiful than the 
spectacle of a youngster led into an alcoholic 
addiction through the influence of older men. 
I am by no means accepting the theory of heredi- 
tary drunkenness when I say that many young 
drunkards are only faithfully following their 
fathers' footsteps, and cannot be justly blamed 
for their error. Too often it is true that they 
literally find themselves unable to catch up with 
their fathers in alcoholic exploits, because their 



240 HABITS THAT HANDICAP 

constitutions, depleted by vicious parental 
habits, prove too weak to stand the pace. 

Even where boys are not unfortunately influ- 
enced by vicious examples offered by their par- 
ents, there are circumstances of our modern life 
that are likely to work havoc with the rising gen- 
eration. The youth who up to his twenty -first 
birthday has been permitted to "have his own 
way" is not likely to have formed the habit of 
traveling in a very good way; nor will he be 
likely to change it for a better one when it is 
proved to him and to his friends and to society 
that it is bad ; for habits form early. Associa- 
tion with thousands of those who have gone 
wrong has proved many social facts to me, one 
of which I mention here despite its apparent ir- 
relevance. The boy who has never known the 
value of money, on whom the responsibilities of 
life have never been impressed, is as seriously 
uneducated as he would be if lack of common 
schooling had left him illiterate. 



CHAPTER XIV 

RELATION OF DRUGS AND ALCOHOL TO INSANITY 

THE habitual drug-taker and the confirmed 
alcoholic are puzzles that baffle the alienist. 
The man with the * * wet brain' ' is a contradiction 
of all the rules of normality. In many criminal 
trials men have been adjudged insane who were 
merely in abnormal states due to the habitual 
use of drugs or alcohol, of which, without proper 
treatment, they have been suddenly deprived. 

In one of the largest hospitals in the United 
States I once ran across an old woman crooning 
while she rocked an imaginary baby. She had 
been formally and legally adjudged insane by 
the State's experts. As a matter of fact, she 
was suffering only from an hallucination due 
to alcoholic deprivation. I suggested definite 
medical treatment for this case when I discov- 
ered that she was about to be transferred from 
the alcoholic ward to the insane pavilion. In 
two days after the administration of this treat- 

241 



242 HABITS THAT HANDICAP 

ment she had lost all her hallucinations, and on 
the third day was dismissed from the institu- 
tion. Not long ago I observed a similar case in 
a foreign hospital. 

It is my belief that commitments for insanity 
in the United States might be decreased by one 
third if in every case where insanity was sus- 
pected, but where an alcoholic or drug history 
could be traced, the patient should be subjected 
to the necessary medical treatment before the 
final commitment was made. The sudden depri- 
vation of drugs and alcohol which follows the 
imprisonment of alcoholics and drug-users upon 
disorderly or criminal charges has produced 
thousands of cases of apparent insanity suffi- 
ciently marked for the subjects to be placed in 
insane asylums. There, as in the prison, no 
intelligent note is made of their condition, nor 
is any proper treatment applied, the result being 
that they become really insane — insane and 
hopeless. If we had any means of securing ac- 
curate knowledge of the number of such incur- 
able maniacs who are now confined in our 
asylums, we should find in it a startling evidence 
of the lack of knowledge on the part of the 
medical world of what deprivation means to the 
habitual victim of drugs or alcohol. 



DRUGS AND INSANITY 243 

GENEEAL IGNORANCE OF THE RELATION OF 
ADDICTION TO INSANITY 

The necessity for educating the public in 
regard to the very definite relation between al- 
coholism and insanity should no longer be over- 
looked. There lies a public peril of unap- 
preciated magnitude in the fact that mere 
deprivation, the only method so far followed, 
has been, and if it is not corrected, will continue 
to be, one of the principal feeders of our insane 
asylums. Alcoholism will lead to insanity even- 
tually even without deprivation. 

The case is somewhat different with drug vic- 
tims. Ordinarily they will not become insane 
unless deprived of their drug, although in the 
final stages of the habit they are likely to become 
incompetent and subject to certain hallucina- 
tions, imagining the existence of plots against 
them, suspecting unfairness on every hand, tak- 
ing easy offense, exhibiting, in fact, a general 
distorted mental condition. It is true, indeed, 
that in some instances the drug victim who is 
deprived of his drug may become definitely in- 
sane, but death is the more frequent result. 

I have before me a clipping from a newspaper 
published in Columbus, Ohio. There, after the 



244 HABITS THAT HANDICAP 

enforcement of restrictive legislation, the au- 
thorities found it necessary to ask the governor 
for some special procedure which would author- 
ize them to supply drug victims with their drugs 
until proper medical treatment was provided. 
This did not relate to those victims who had 
come exclusively from the under-world, but re- 
ferred specially to those habitual drug-users 
whose habits had been acquired through illness. 
It can scarcely be expected that restrictive legis- 
lation will entirely prevent the sale and use of 
drugs in the under-world any more than restric- 
tive legislation has been able to prevent the 
practice of burglary or any other type of crime 
or lawlessness. It is highly probable that the 
under- wo rid will always be able to get its drugs ; 
but it is nevertheless true that the passage of 
restrictive legislation and the enforcement of 
such laws will tend to prevent the descent of 
many into the criminal class. 

Even this is comparatively unimportant. 
Those who sutler most are those who have been 
given the habit by physicians. These are hon- 
est drug-users, and to them at this writing no 
helping hand is anywhere held out save in New 
York State. I have been somewhat disgusted-— 
I am sure that is the word I wish to use — by the 



DRUGS AND INSANITY 245 

continual outpouring of sympathy and constant 
manifestations of anxiety on the part of good 
people in regard to the under-world, when these 
same good people regard with indifference or 
classify as criminal the involuntary victim 
toward whom the most intense and understand- 
ing sympathy should be extended. 

MENTAL ATTITUDE OF THE DRUG-TAKER AND 
THE ALCOHOLIC 

The victim of drugs psychologically differs 
very materially from the victim of drink. Until 
his trouble has reached an acute stage, the alco- 
holic feels little interest in any of the methods 
advertised as remedial for alcoholism. Many 
men deny to their friends and even to them- 
selves that they are alcoholics until they have 
reached a point akin to hopelessness in their 
friends' eyes and their own. The drug-user, on 
the other hand, knows that he is a victim as soon 
as he becomes one ; in ninety-nine cases out of a 
hundred he is immediately filled with an intense 
longing to be relieved of his habit. Thousands 
of alcoholics will defend their vice. A library 
might be filled with books, fictional and other, 
glorifying alcohol and the good-fellowship and 
conviviality that it is supposed to promote. 



246 HABITS THAT HANDICAP 

One might search a long time for a victim of 
any drug habit who would speak with affection 
of the material which has enthralled him. No 
poet has ever written any song glorifying mor- 
phine. There is no drug-user in the world who 
would not hail with joy any opportunity that 
might lead to his relief. The drug-victim inves- 
tigates every hint of hope with eager interest, 
reading, intelligently questioning, experiment- 
ing. He shrinks from publicity with a horror 
that is backed by an acute consciousness of his 
condition, while the victim of alcohol becomes 
so mentally distorted or deadened that he takes 
no thought of consequences, cares nothing for 
publicity, and finds himself unable to avoid pub- 
lic exhibitions of a kind that put him into the 
hands of the police. Public hospitals do not 
tempt the drug-user for, having investigated 
them, he knows that they are not competent to 
give him real relief. 

EXPEDIENTS OF DRUG-TAKERS 

Nothing but really enforced restrictive legis- 
lation, fashioned after the model of the present 
New York State law, will bring to light the drug- 
victims in any community. The New York law 
uncovered thousands of them, and within two 



DRUGS AND INSANITY 247 

weeks forced Bellevue and other hospitals to 
devote many beds to sufferers from drag-depri- 
vation. Similar restrictive legislation would 
uncover every sufferer from drugs in the coun- 
try and thus accomplish more good than could 
be achieved by any other similarly simple 
means. No man on earth is more pitiably af- 
fected than the drug-taker; no suffering is more 
intense than his when deprived of his drug. The 
fact that rather than undergo such suffering 
men and women will resort to the most desperate 
expedients has been proved a thousand times. 
When confronted by the terrible prospect of 
deprivation, they invented plans worthy of the 
mental agility of the most famous fictionist. 
Drugs were smuggled into prison hidden in 
the heels of visitors' shoes. One wife who knew 
the agony her husband must endure if deprived 
of his regular morphine dosage took to him 
clean linen which was admitted to the prison 
without question, but which, as an accident re- 
vealed, had been " starched' ' with morphine. 
Another ingenious wife or sweetheart devised 
the expedient of sending in to a prisoner 
oranges from which the juice had been cleverly 
extracted and which had been filled hypoder- 
mically with a morphine solution. 



248 HABITS THAT HANDICAP 

If there is no length to which a drag victim 
will not go rather than find himself deprived of 
his drug, there is no length to which he will 
not go in order to obtain relief from a habit 
the existence of which fills him with horror. 
This has often been illustrated in the course of 
my practice, but perhaps never more strikingly 
than when I learned of the experiences of a 
certain judge in Jacksonville, Florida. This 
far-sighted, merciful, and progressive jurist had 
come in contact with one or more pitiable cases 
of the drug habit to which he wished to give re- 
lief. He communicated with me, and I was very 
glad to cooperate in aiding with definite medical 
relief several drug-victims taken before him. 
This procedure was commented upon in the pub- 
lic press, and presently the judge found himself 
importuned for help by those who had com- 
mitted no crime, but expressed themselves as 
quite willing to be sent to prison as the only way 
in which they could get the treatment that was 
being administered under his auspices. 

DKTJG-TAKING MOEE OFTEN" THE CAUSE THAN" THE 
EESULT OF CBIMINALITY 

A careful study of the histories of drug-takers 
who upon one charge or another find themselves 



DRUGS AND INSANITY 249 

caught in the meshes of the law will reveal that 
in most cases, or at least in many cases, the drug 
habit has led to crime rather than the reverse. 
If an efficient treatment for the drug habit were 
established in a prison almost anywhere in the 
United States where such a treatment did not 
elsewhere exist, it would result, I am sure, in 
the actual commission of crimes by a certain 
number of people willing to endure the misery 
and disgrace of incarceration for the mere sake 
of securing treatment for their affliction. Any 
drug-user will tell you that no punishment re- 
corded in the course of human history, no tor- 
ture visualized by the most inventive imagina- 
tion, can compare with the unspeakable agony 
of deprivation. 

FALLACY OF IMPRISONING DRUG-TAKERS 

That imprisonment should rarely, if ever, re- 
sult in freeing a person from the drug habit can 
mean only one thing: that drugs are obtainable 
in every prison. Guards and other employees 
in such institutions are of a low class, for men 
and women of a high type are unlikely to seek 
such employment. I fear that this fact will 
prove one of the most serious stumbling-blocks 
in the path of those who are endeavoring to 



250 HABITS THAT HANDICAP 

make a success of inebriety-farm experiments. 
In the first place, they will not be able to find 
men of a high type anxions to serve in the sub- 
ordinate positions provided at such places ; and 
in the second place, even if such men can be 
found, they will be unlikely to obtain positions 
because persons of an inferior type will be cer- 
tain to be pushed forward by political influence. 
Such places would be used as means wherewith 
to pay political debts, and this would be more or 
less complacently tolerated, because society has 
always underrated and still underrates the ter- 
rific complications of the task of working for 
the reclamation of, or even caring for, the down- 
and-out. Such work is not employment for the 
saloon-keeper, the ward heeler, or the ex-prize- 
fighter, and of such is the personnel of most 
prison staffs made up. The reclamation of the 
alcoholic wreck means far more than physical 
rehabilitation. It means moral and psycholog- 
ical regeneration, and such work can be done 
only by people of understanding and delicate 
sensibility. The alcoholic from the city who 
has been perhaps an office employee or a pro- 
fessional man and who is sent to an inebriate 
farm will find there nothing curative save depri- 
vation. Even if outdoor work will harden his 



DRUGS AND INSANITY 251 

muscles, it must be admitted that the surround- 
ings in which this is accomplished may well 
ossify his brain. 

PSYCHOLOGY OF THE DRUG HABIT 

Nothing could more clearly indicate the popu- 
lar ignorance concerning the drug habit than 
the general belief that it is usually accompanied 
by moral deterioration. Where the habit is an 
accompaniment of life in the under-world, moral 
deterioration of course exists, though this is due 
rather to the under-world than to the drug 
habit. In the thousands of histories where the 
habit has been acquired by the administration of 
drugs by physicians it results in moral deterio- 
ration no more than drinking tea does. As a 
matter of fact, that portion of society which 
holds a drug victim blamable is woefully mis- 
taken and inhumanely unmerciful, the truth 
being that the man or woman who is not taking 
drugs is lucky. 

THE NECESSITY OF DEFINITE MEDICAL TREATMENT 
IN DEALING WITH ANY FORM OF ADDICTION 

It is impossible for me to conclude this book 
without discussing further the question of treat- 
ment for those afflicted with habits or addictions. 



252 HABITS THAT HANI K ^P 

My taking up this work in 1901 was dne al- 
most entirely to an investigation into the meth- 
ods employed to restore those who had lost con- 
trol through the nse of habit-forming drugs, 
whether they had acquired the habit through 
dissipation or from the administration of the 
drug by a physician on account of illness or in- 
jury. At that time such cases were supposed to 
be hopelessly incurable, and the victims only 
drifted from bad to worse until they had been 
accounted for either in a mad-house or in the 
morgue. 

I found, on making inquiries from some of the 
leading medical men who had been dealing with 
the various types of mental and nervous dis- 
eases, that they were virtually unable to name 
any case of a confirmed drug-user who had been 
permanently benefited by institutional or any 
other means of treatment. This was very diffi- 
cult to understand, particularly in the ease of 
drug-users who had acquired the habit through 
the administration of the drug by a physician, 
and who earnestly desired to be freed from the 
habit. It seemed incredible that a skilled phy- 
sician could not eliminate the craving or desire 
for the drug, or restore these unfortunates to 



DRUGS AND INSANITY 253 

the point where their systems would not demand 
or feel the need of it. 

I soon found out why this was so. My inves- 
tigation showed me that the drug habit is a men- 
tal as well as a physical condition ; that the phy- 
siological action of an opiate is to tie up the 
functions, resulting in a deterioration of the 
vital organs when the victim has taken the drug 
sufficiently long to set up a definite tolerance. 

The medical world had apparently been un- 
able or had not attempted to bring about a defi- 
nite physiological change, and to place such 
patients where they would not crave drugs and 
where their systems would not demand them. 
To my further surprise, I found that the medi- 
cal world had been depending entirely on depri- 
vation as a means of treating such cases. They 
would immediately send patients to an institu- 
tion where they were put under surveillance and 
guarded by attendants, or they would attempt 
by gradual reduction of the dosage to eliminate 
the habit. 

CUKE BY DEPKIVATION IMPOSSIBLE 

This investigation led me into some very in- 
teresting discoveries. I found that old, con- 



254 HABITS THAT HANDICAP 

firmed subjects of the drug habit were sent to 
such institutions. Where they were taking 
large daily doses of opiates the institutions were 
able to reduce these people, when there was no 
underlying physical disability, within a few 
weeks or a few months, according to the tem- 
perament of the patient, to a very small daily 
dosage, often as low as one half or one eighth 
of a grain a day. When they had reached this 
dosage it was often found absolutely impossible 
to limit them further. In some cases where the 
patient was confined and finally deprived of the 
drug entirely I found that when he had reached 
this minimum dosage he would suffer just as 
much physical discomfort in the end as if he 
had been suddenly deprived of a very much 
larger quantity of the drug taken daily. This 
led up to the further interesting fact that even 
where patients were finally deprived of the drug 
and lived through the horrible suffering inevi- 
tably accompanying the deprivation, although 
they outlived the tremendous depression and 
lassitude which followed, and for long periods 
of weeks and months after that time had the best 
of care and attention until they showed marked 
improvement in their physical condition, never- 



DRUGS AND INSANITY 255 

theless, with too few exceptions, they never lost 
the desire for the drug. Always the need of 
some stimulant returned, and on the slightest 
excuse or opportunity they were taking their 
drug again. My investigation finally proved to 
me that deprivation did not remove the cause of 
the drug habit, because it did not remove the 
physical craving for the drug. No matter how 
long a period the deprivation had been, the 
needed physical and mental change had never 
taken place. 

EFFICACY OF THE AUTHOR 'S TREATMENT 

During the first two years of my work, after 
finding in various ways patients from the under- 
world to use as subjects for demonstration, I 
was finally able to treat any case of drug habit 
which came to me unless it was complicated by 
underlying physical disability. After a period 
of from three to four days these patients would 
not feel the slightest craving or desire for any 
form of opiate, whether their addiction had been 
cocaine, alcoholic stimulants, or tobacco. 

When the efficacy of this treatment was as- 
sured, it began to attract the attention of some 
of the best-known medical men in the country — 



256 HABITS THAT HANDICAP 

men who were interested in this line of study. 
They followed carefully the medical administra- 
tion of the new treatment of these cases. 

It was only a matter of time before the value 
of the work was thoroughly established and be- 
came a medical fact, After hundreds of definite 
clinical histories had been recorded, the formula 
was publicly announced, first, at the Interna- 
tional Opium Conference at Shanghai in 1909, 
and a month later to the medical world. Since 
the complete information concerning my work 
has been given to the medical profession, and 
after all these years of study and investigation 
and medical comment, I have never yet had from 
any physician an entirely satisfactory explana- 
tion as to why or how we were able successfully 
to unpoison these cases in this short period. 
At present this treatment is, so far as I know, 
the only one known to medical science that will 
bring about this definite physiological change. 

The intelligent beginning of help in these 
cases is to unpoison the patient, put him physi- 
cally on his feet, where he does not want drugs 
or drink, and where he does not feel the slight- 
est desire or craving for them, a^id has no dread 
of ever drifting into these habits again. When 
you have brought about this definite physical 



DRUGS AND INSANITY 257 

change, you are invariably able to get a definite 
mental change. You cannot hope to get the 
mental change until you have first cleared the 
system of poison, for in this state the patient is 
in a most responsive condition to deal with. 
If physical building up, change of environment, 
change of surroundings in any way whatever are 
necessary, they can then be taken up intelli- 
gently. 

LEGISLATIVE EFFORTS 

The knowledge I gained from dealing medi- 
cally with those afflicted with habits and addic- 
tions led me to take up personally the movement 
to bring about definite legislation with a view 
to subordinating as much as possible the traffic 
and consumption of drugs to legitimate medical 
needs ; and to put an end to the criminal negli- 
gence by which such drugs have been permitted 
to be imported, manufactured, and distributed. 

In contact with the afflicted of this class, I dis- 
covered the laxity with which drugs were dealt 
in, and began in 1912 to try and bring about 
some restrictive legislation with regard to the 
evil before the New York legislature. I had 
first found that in the medical use of the drug 
the principal evil had sprung from the knowl- 



258 HABITS THAT HANDICAP 

edge of what would ease pain, and that the prin- 
cipal means used for this purpose was the hypo- 
dermic syringe. At that time there was no 
restriction placed upon the sale of this instru- 
ment ; it could be bought in any drug store just 
as easily as a package of chewing-gum. The 
department stores that carried drug supplies 
advertised hypodermic outfits as low as twenty- 
five cents. A physician's instrument permitted 
to be manufactured and sold in this way! 
Through the bill which was introduced in the 
Xew York legislature in 1912, for the first time 
in the history of the medical world it became 
possible to purchase this instrument only on a 
physician's prescription. 

In 1913 I was the author of a drastic law reg*u- 
lating the sale of habit-forming drugs in Xew 
York State, but because of severe pressure 
brought by physicians and druggists, I was un- 
able to put it through. In 1911 I tried again, 
and after a hard fight I was able to have enacted 
a bill, which was introduced by Senator John J. 
Boylan, and which bears his name. For the 
first time there was put upon the statute-books 
of a State real restrictive drug legislation. 
Other States are taking up this matter, and, as 
the intention was, the Xew York bill has been 



DRUGS AND INSANITY 259 

the means of establishing a legislative prece- 
dent. 

I regret very much that the aim and purpose 
of Federal legislation has been largely defeated 
by the powerful drug interests, but I predict that 
it is only a matter of time before public senti- 
ment will defeat this powerful drug lobby, as 
it has always defeated other lobbies of a simi- 
lar kind, and that the country will be largely 
freed from the illegal habit-forming drug traf- 
fic. 

Until there is some international understand- 
ing between the countries that produce these 
drugs and the countries that consume them, we 
shall have to submit to more or less smuggling 
of these drugs into our country. Smuggled 
goods rarely, if ever, find their way into chan- 
nels for legitimate medical needs, and for that 
reason it is only the under-world that would be 
affected by their use and abuse. 

It is only a matter of time before the commis- 
sioners of health for the various States will be 
given authority enabling them to issue rules and 
regulations governing the health of the people 
that will wipe out the quacks and charlatan 
venders of all common advertised fake medicine 
cures. 



260 HABITS THAT HANDICAP 

THE NEED FOE REGULATING THE ADMINISTRATION 

OF DRUGS 

I have been told that to require a consultation 
of physicians before the administration of a 
habit-forming drug would put upon the patient 
a financial burden which he should not be asked 
to bear. No fallacy could be more complete. 
There is in the United States to-day not one 
victim of the drug habit who, knowing as he does 
the intense suffering it entails, would not rather 
have given up ten years of his life and been 
forced to put a mortgage on his soul than to 
have had this habit fastened on him. Money? 
Money is nothing! The cost of a consultation 
is a small price to pay for the possible difference 
between life-long thralldom and free manhood 
or womanhood. And let me add in regard to 
the physician who objects to the legal establish- 
ment of a danger-point in drug administration 
that the physician who feels big enough to accept 
personally the responsibility of creating a drug 
habit is too small to be intrusted with that 
power. 



DKUGS AND INSANITY 261 

PERCENTAGE OF THOSE TO WHOM THE PERMANENT 
ADMINISTRATION OF DRUGS IS A NECESSITY 

The percentage of sick people to whom the ad- 
ministration of habit-forming drugs is a neces- 
sity for the preservation of life or comfort is 
smaller than is generally supposed even by the 
medical profession. When I was drafting my 
restrictive bill to be introduced into the New 
York legislature, I was asked by my lawyer to 
enumerate those physical troubles which de- 
manded the constant use of habit-forming drugs. 
I found this to be impossible. I have known 
many instances in which to deprive of drugs 
patients suffering incurable illness would have 
been little less than criminal. This alone en- 
abled them to live in comparative comfort. 

I have known of many cases of drug habit 
which have grown out of the administration of 
morphine for recurring troubles, such as renal 
colic. Such a disorder as this, however, should 
never give rise to a drug habit, because those 
suffering from it are subject to such brief peri- 
ods of pain that a physician could administer 
the necessary drug without their knowledge. I 
have had many cases of women who, acquiring 
the habit through the administration of drugs 



262 HABITS THAT HANDICAP 

at the time of their monthly periods, became ha- 
bitual users, although each recurrence of the 
pain lasted only three or four days. When this 
problem is thoroughly understood, such cases 
will be impossible, for legislation will not only 
prevent the layman from securing habit-forming 
drugs, but will prevent the doctor from the in- 
discriminate administration of them. 

Of course the general reader may think this 
book merely a clever advertisement. In it I 
state that it is wrong to stop the use of morphine 
and alcohol unless the victims can be treated for 
the habit, and next I condemn doctors and sana- 
toriums for their useless methods of treatment, 
while lauding my own. Naturally, my reader 
may assume that my only motive is the selfish 
one of money. 

Well, one may suppose what he likes, but the 
truth is that I urge every city and State to estab- 
lish places that will drive me out of business. I 
urge physicians to take up this treatment and 
cure their own colleagues. I have no secrets. 
My methods have been published, and I am now 
devoting most of my time to legislative work 
from which I do not profit a cent. 



APPENDIX 



THE EELATION OF ALCOHOL 
TO DISEASE 

BY 

ALEXANDER LAMBERT, M.D. 

Visiting Physician to Bellevue Hospital; Professor of Clinical 
Medicine, Cornell University 

Author of "Hope for the Victims of Narcotics" 

IN the simple heading of the subject-matter 
of this article there are contained such pos- 
sibilities of facts and fancies, truths and errors, 
and wide differences of opinion, that it seems 
wise to define not only its meaning, but some of 
the words themselves. What is disease? To 
many people it is a definite, concrete thing which 
seizes one in its clutches, holds one captive or 
possesses one for a second time, and then if over- 
come releases its grip and one is free and in good 
health again. But disease is not an entity, even 
though some agents, as bacteria, are living or- 
ganisms. It is the lack of some processes which 
these agents overcome, and others which they 
set in motion, as manifested by disturbances of 

265 



266 APPENDIX 

various functions of different organs in the 
body that make up some of our diseases. Our 
bodies are often in a state of delicate equilib- 
rium, and if some one gland fails to secrete, or 
secretes too abundantly, the resulting condition 
may become a disease. As health is a harmoni- 
ous relationship between the various functions 
of different parts of the body, so disease is a dis- 
turbance of this harmony. The question of the 
relation of alcohol to disease becomes a question 
as to whether or not this narcotic if taken into 
the body can react on the various tissues and 
organs of the body to such a degree as to disturb 
the equilibrium of health. And, furthermore, 
can this disturbance of healthy equilibrium be 
permanent and the body acquire a lasting dis- 
eased condition? 

HOW IT AFFECTS DIFFEEENT MEN 

Alcohol is classed here as a narcotic and not 
a stimulant, because we shall see later that alco- 
hol is rather a paralyzer of functions, even when 
it seems to stimulate, than a producer of in- 
creased output from any organ. The time hon- 
ored idea that alcohol is a stimulant and that, if 
used in moderation, it is a tonic, is so ingrained 
in the average mind that it is with the greatest 



APPENDIX 267 

difficulty that men can be made to realize that 
even in what seems moderate doses it may in- 
jure them. This is especially true as one sees 
men who all their lives have indulged moder- 
ately in alcoholic beverages from which seem- 
ingly no harm has resulted. The truth, per- 
haps, is best summed up by the old adage that 
what is one man's meat is another man's poison, 
and there is no question that the effects of alco- 
hol in small or moderate doses is vastly different 
from its effects in large doses, or in long contin- 
ued, excessive use. Different human beings re- 
act differently to similar amounts of alcohol, 
and conversely, identical amounts of alcohol will 
affect different individuals in different ways, 
even when it poisons all of them. For instance, 
if alcohol sets different processes in motion 
which bring about damage to the individual, we 
find that in some persons it has injured the heart 
and arteries, in others it has affected the liver or 
stomach, leaving the brain and nervous tissues 
free from damage, while in still others the body 
in general seems to be untouched and the brain 
and nervous tissues suffer the injuries. It is 
not uncommon to see a man who has partaken 
freely of alcoholic beverages all his life with 
neither he nor his friends conscious that his 



268 APPENDIX 

intellect has suffered or deteriorated thereby, to 
find suddenly that his circulatory and digestive 
systems are seriously and permanently dam- 
aged. On the other hand, many a drunkard has 
become a burden to his family and the commu- 
nity, with his personality deteriorated, his intel- 
lect rendered useless, while his circulation and 
digestion remain unimpaired, and he lives long 
years a nuisance and a burden to his environ- 
ment. 

Since I have made the distinction between 
moderation and excess in the use of alcohol, it 
will be well to define what is regarded as excess, 
and what moderation, in order that the effects 
of both may be considered. Physiologic excess, 
it seems to me, has been best defined by a bril- 
liant Frenchman named Duclaux, who says that 
any one has drunken alcohol to excess who one 
hour after he has taken it is conscious in any 
way of having done so. If after a drink of any 
alcoholic beverage has been taken, wine, whis- 
key, or whatever it may be, an hour later we feel 
ourselves flushed, tongue loosened, or if we are 
heavy and drowsy, or, if we find our natural re- 
serve slightly in abeyance, if the judgment is not 
as sternly accurate as before partaking of the 
beverage, if the imagination is unusually active 



APPENDIX 269 

and close consecutive reasoning not as easy as 
before, if we think we do our work much better, 
but next morning realize we haven't accom- 
plished quite as much or done it as well as we ex- 
pected, then we have shown a physiologic exces- 
sive intake of alcohol, and an amount which if 
continued will produce damage somewhere in 
the "body. Moderation in the use of alcohol 
means that it be taken in amounts of which one 
remains unconscious. This may seem a narrow 
and hard line to draw, and may seem to confine 
the amount of alcohol that may be consumed to 
much less than many people wish to indulge in. 
How much in actual amount this should be with 
any given individual depends upon that indi- 
vidual alone, and no one can be a law to any 
other individual than himself. If a man be en- 
gaged in severe manual labor or muscular exer- 
cise, he can consume more alcohol without 
detriment than when leading a sedentary life, 
although the character of the work that he will 
do may not be as good as if no alcohol were 
taken. 

THE MODEKATE USE OF ALCOHOL 

The above definition, however, must suffice. 
We must fix some standard between moderation 



270 APPENDIX 

and excess, and the more accurately we define 
moderation, the more narrowly do we confine it. 
Jndge by the above standard, alcohol taken in 
moderate doses does not seem more than to stim- 
ulate the digestive processes of the stomach, in- 
crease the flow of blood through the heart, in- 
crease the circulation in the periphery and skin, 
dilate the capillaries, and make it easier for the 
circulation to complete its cycles. When ab- 
sorbed into the body in such doses, it can act as 
a food, and, in fact, as much as is burnt up by 
the body does act as a food, although it differs 
from other foods in that it is never stored up. 
It can replace in energy-giving properties su- 
gars or fats, and being burnt up by the body can 
give out the equivalent of sugar and fat in mus- 
cular energy, and heat generated and given out 
by the body. Its effect is similar to that ob- 
tained by sugar and fats which are taken up by 
the body when needed and in the amounts 
requisite to the body at the moment, and it seems 
to be treated as far as can be seen as other foods 
for fuel. But it is not an economical fuel be- 
cause the human organism does not perform its 
work as well as when there is no alcohol in the 
ration. Simultaneously when being consumed 
as food it is exerting its drug action. In this 



APPENDIX 271 

process it is the more easily available, and thus 
the sugar and fats are stored up while the alco- 
hol is burnt up ; it spares the fat consumption, 
often causing an increase of bodily weight 
through the putting on of fat. To those who 
are accustomed to its use, it seems also to spare 
the protein consumption of the body, but to 
those unaccustomed to its use it has the opposite 
effect, increasing the destructive breaking down 
of proteins. 

DANGEK SIGNALS UNHEEDED 

Moderate indulgence in alcoholic beverages 
adds to the pleasures of existence with a great 
many men, and while it seems to increase their 
pleasures and broaden the extent of their mental 
experiences, it cannot be said to increase their 
powers of accurate mental activity, though it 
temporarily increases the imaginative flow of 
ideas. It relieves the feeling of both body and 
mental fatigue for the time being, an effect which 
may be an advantage or may be a distinct disad- 
vantage, for fatigue is Nature's warning when 
to stop, and if we dull ourselves to this feeling 
and leave the warning unheeded, we may easily 
go on to harmful excesses of overwork and over- 
exertion. It is doubtful if the moderate drink- 



272 APPENDIX 

ing of alcohol, as we have defined moderation, 
sets in motion pr<: sesses which may so disturb 
the eqnilibrinm of the body as to cause disease. 
Broadly speaking, the excessive use of alcohol 
injures the body in two ways. It injures the 
functional cells of the different organs for alco- 
hol is distinctly a cellular poison, and it further 
disturbs the nutrition of the organs by its in- 
jurious action on the blood vessels which supply 
nutrition to the various parts of the body. 
"Wit^t: to replace the destroyed cells or as a 
result of the congestion there is also an increase 
in the connective tissue framework of the vari- 
ous organs. The action of alcohol on the circu- 
lation is one of the earliest effects which is 
shown after it is taken into the body. The flush- 
ing of the skin is a beginning paralysis of the 
minute capillary blood vessels. If habitually 
indulged in, the effect is a continuous dilatation 
of the vessels, although it seems for a while in 
the early stages :"iiat there is a toning up of the 
circulation. Yet excessive indulgence brings 
with it always a lowering of the blood pressure 
and finally the chronic congestions in the inter- 
nal viscera. The action of the heart at first is to 
make it beat fuller and stronger, but if con- 
tinued, the effect is also one of paralysis of its 



APPENDIX 273 

muscle and a diminution of the output of work 
done, and finally it is a paralyzer of the heart's 
action. In some persons, through its injury to 
the cardiac blood vessels and intrinsic muscle 
of the heart, it sets in motion those morbid 
processes which result in angina pectoris. 

Beginning with the stomach, we find that when 
alcohol is taken in excess it not only disturbs 
the processes of digestion that are then going 
on, if it is taken in greater amount than five per 
cent, of the stomach content, but it also acts di- 
rectly on the mucous membrane, producing an 
irritant action. We have formed here a chronic 
congestion of the mucous membrane which pro- 
duces swollen cells, and the digestive glands of 
the stomach produce an excess of mucus which 
interferes with digestion, and the resulting con- 
gestion interferes with the gastric secretions. 
It ends in producing a swollen, inflamed mucous 
membrane, often with hemorrhages. These 
processes may go on to an atrophic form of 
gastritis, in which the mucous membrane may be 
so atrophied that it is unable to secret sufficient 
gastric juice. The acid of the gastric juice, 
combining with certain substances in the intes- 
tine, is one of the stimulants which causes the 
production of the pancreatic secretion. The 



274 APPENDIX 

pancreas not alone digests the meats and other 
proteids, but it changes starch into sugar, and 
also has a fat splitting ferment. Thus we see 
that pancreatic digestion is a most important 
function, and does much more in the digestive 
work than the stomach. When therefore the 
acids of the gastric juice are lacking, there is an 
insufficient stimulus to the pancreas to pour out 
its complex juices and complete digestion. 

THE ATTACK UPON THE LIVER 

Alcohol is so rapidly absorbed from the stom- 
ach and the upper intestine, that it does not as a 
rule produce much change in the small intes- 
tines. The absorption of the digested food from 
the intestinal tract by alcoholics when recover- 
ing from a debauch is greater than normal, pro- 
vided they have ceased from their alcohol. The 
absorbing powers of the intestine remain a long 
time, and is the reason that so many alcoholics 
appear so well nourished. The acids of the gas- 
tric juice also stimulate the excretion of bile 
from the liver, and combining with the same fer- 
ment, the secretion, being taken up by the blood, 
stimulates the liver to an increased secretion of 
bile. If therefore one has so injured the stom- 
ach with the taking of alcohol that the mucous 



APPENDIX 275 

membrane is unable to secrete a proper gastric 
juice, it is readily seen that the proper stimula- 
tion to the liver and the pancreas are lacking, 
and the equilibrium of the entire digestive pro- 
cess of the body is upset. The blood from all 
the intestines goes directly to the liver, the cir- 
culation of this organ being so arranged that the 
blood must filter through and bathe the liver 
cells before it is gathered into a central vein and 
returns into the general circulation. In fact the 
liver is the great chemical laboratory of the 
body, and the complex processes that go on there 
are as yet but little understood. The processes 
which I have described as generally characteris- 
tic of alcohol are seen to a very marked extent 
in the liver. There is a chronic congestion, and 
there is very frequently various forms of degen- 
eration in the hepatic cells, and in many cases 
an increase in the connective tissue to such an 
extent as to cause the disease known as cirrhosis 
of the liver. 

Alcohol may also under certain circumstances 
produce such excessive fatty degeneration in the 
liver, as in itself to be a menace to existence, for 
if the liver ceases to do its proper work, the 
whole minute nutritive chemistry, the metabol- 
ism of the body, breaks to pieces. The liver 



276 APPENDIX 

stands an enormous amount of use and abuse, 
and it is one of the last organs to give Tray under 
great strain, but when its functional processes 
do break down, the existence of the individual 
is not much further prolonged. The liver can 
consume and break down a certain amount of al- 
cohol, but when more is poured into it than it can 
assimilate, some of it must go through into the 
general circulation and over the body, flowing 
to the brain and poisoning this organ, and the 
other nervous tissues. 

The action of alcohol on the nervous tissues 
constitutes, in the eyes of the majority, the main 
injury that alcohol does to a human being. 
Certain it is that the action of alcohol on the 
brain does more to distort and pervert a man's 
relationship with his environment than any 
other action which alcohol has on the bodv. It 
is through the poison of this organ that the per- 
sonality of the individual is so changed and so 
poisoned that a degeneration of the individual in 
character and morals is brought about. It is 
here, too, that the widest differences of tolerance 
and intolerance to alcohol are shown. Some 
men may consume enormous quantities and their 
mental balance apparently remain intact. 
Other individuals cannot take a single glass of 



APPENDIX 277 

wine without being distinctly affected by it, or 
rendered unmistakably drunken. The gross 
injuries found in the brain of those dying from 
the effects of alcohol are partly due to the effect 
of alcohol on the circulation and the injury to 
the blood vessels, thus diminishing the nutrition 
of the brain and injuring the brain tissue itself, 
and besides, as we have seen in other viscera, to 
the increase in connective tissue. 

It is not necessary here to go into the details 
of the minute formation of the cells, how each 
cell is formed of a cell body and many branches, 
as one may conceive, growing like a tree or bush 
with the many branches stretching out and 
touching other branches of related and adjacent 
cells. When these dendrites or branches are in 
contact, there is an interrelationship between the 
processes of the two cells. Alcohol causes a re- 
traction of the tiny branches one from another 
and the cells are dissociated, so that the men- 
tal processes become dissociated from each 
other, and the cells themselves degenerate and 
are unable to carry on their functions ; thus we 
see the functions of memory and of the repro- 
duction of images by memory prevented, the 
inability of the mind to reason, through the in- 
ability of the mind to call up former experiences, 



278 APPENDIX 

feelings and ideas, and a weakening of the power 
of each cell to take in impressions. 

Every person who drinks alcohol to excess 
will not show every form of mental deterioration 
that may be produced by excessive indulgence, 
and the degree of deterioration in intelligence 
which goes to make up the sum total of mentality. 
varies greatly in different individuals. All who 
drink alcohol to excess, however, show some 
diminution in their judgment. Judgment means 
the power of recalling various memories of per- 
ceptions through the senses, which have come in 
from the outside world, memories of ideas, mem- 
ories of emotions, and all the complicated asso- 
ciation of ideas that these bring up, and in the 
recalling of them weigh each one with the other 
and judge of the value between them. This also 
means reasoning and decision for action. This 
power of reasoning and judging is weakened in 
the alcoholic, and in any brain long poisoned by 
alcohol it is an impossibility to exercise it. 
Memory itself is also weakened. There is ex- 
cessive forgetfulness of the recent past, and in 
some cases of advanced alcoholism there is abso- 
lute forgetfulness of wide gaps of years ; a man 
may be unable to remember anything from the 
last five minutes back for twenty years, and then 



APPENDIX 279 

remember back to childhood. The memories of 
childhood are more easily stamped on the brain 
than are those of adult life, both because it takes 
less to impress a child, and because there is not 
the complexity of ideas crowding into the brain, 
nor the complexity of association of ideas to be 
recorded. Therefore memories of childhood 
make a deeper impress and last longer, and so 
the complex memories of the adult are the first 
to be forgotten in the alcoholic, and those of 
childhood remain. 

EFFECT UPON MEMOEY AND JUDGMENT 

Besides the absolute forgetfulness, there is 
another form of forgetfulness in the alcoholic 
which often produces a ludicrous result. This 
is a perversion of memory. The person may be 
in a perfectly strange place and meet strangers, 
and yet be convinced that he has seen the place 
and met the strangers before, and greet them as 
old friends. This feeling of having been there 
before occurs in normal, healthy people, and may 
be simply the expression of momentary fatigue, 
or proceed from some unknown cause ; but it is 
grossly exaggerated in the alcoholic, and cannot 
as easily be straightened out as in the normal 
mind. 



280 APPENDIX 

The imaginative faculties of the mind are at 
first heightened by alcohol, and this often pro- 
duces bright, witty remarks in those who have 
taken enough alcohol to have their imaginations 
stimulated and their judgment slightly inhibited, 
so that their ideas crowd readily to their minds 
and their tongues are loosened. Often, how- 
ever, they say things which though bright and 
witty had better be left unsaid, and this is an in- 
dication of the beginning paralysis of their judg- 
ment. The imaginative faculties, however, are 
not constructively increased by alcohol, and it 
does not conduce to reproduction and creative 
ability, which requires memory and constructive 
thought. In this connection Kraeplin's experi- 
ments have shown that alcohol makes easy the 
liberation of movements from the cortical areas 
of the brain, that is, the transformation of ideas 
and memories of movements into deeds, but no 
real mental power is given ; for while a man may 
feel that he is doing things better with than with- 
out alcohol, as a matter of fact he is not doing 
them so well. This sense of self-approbation is 
very characteristic of the alcoholic. His judg- 
ment is gone, not only in regard to his mental 
processes, but very essentially regarding him- 
self, and it may be truly said that while alcohol 



APPENDIX 281 

shrinks the judgment, it swells the self-conceit. 
This abnormally good opinion of his diminished 
abilities renders the alcoholic exceedingly com- 
placent ; he is persuaded that at any time he can 
give up drinking if he chooses, and he is unable 
to appreciate the rapid deterioration of his intel- 
lect. One cannot separate the will of an indi- 
vidual from his personality, and the weak-willed 
individuals, while they may possess many other 
agreeable characteristics, are lacking in the pro- 
gressive force which strong characters possess. 
Alcohol weakens the will, causes the personality 
itself to deteriorate, and there is a lack of initia- 
tive; there is the ever ready specious explana- 
tion why nothing is ever done ; there is a boast- 
ful conceited estimation of what can be done. 
With the judgment perverted the alcoholic can- 
not act at the proper time in the right way, no 
matter how much he may be willing to admit the 
necessity for correct action, and on the other 
hand he is equally powerless to prevent wrong 
action on his part, especially when such action 
has anything to do with a further indulgence in 
his alcohol. 

The emotional side of the personality shows 
the same deterioration from the higher to the 
lower, as do the other intellectual processes. It 



282 APPENDIX 

is the same story that the last to come are the 
first to go, and the first to come are the last to 
go. All emotions of refinement, those of the 
esthetic development, disappear the earliest. 
The sense of affection and moral responsibility, 
dnty to family and friends deteriorate and van- 
ish. There is nothing left but the consideration 
of what affects the self, and an alcoholic is the 
most studied, selfish soul that exists. The re- 
maining emotions of anger, fear and nutritional 
reaction for food and drink remain to the last, 
as these are the most primitive of the emotions. 
With the weak will preventing action, and with 
the loss of memory and inability for continuity 
of thought, we find the emotion of fear predom- 
inating to a very noticeable extent. This is true 
whether the alcoholic be delirious or not, for in 
all forms of alcoholic delirium, fear is a very 
predominant symptom. In some forms of de- 
lirium tremens, the intensity of the fear is a fair 
criterion of the degree of the poisoning. The 
various senses of sight, hearing and taste are 
dulled, because the cells producing the mental 
perceptions are equally poisoned with the rest 
of the mind. 



APPENDIX 283 

WEAKENING THE MORAL FIBER 

With the inaccuracy of sense perception and 
loss of memory and diminished judgment, one 
cannot be surprised to find that alcoholics are 
notoriously inaccurate, unreliable and untruth- 
ful. They cannot tell the truth even with assist- 
ance. But often what is credited to them as un- 
truthfulness is mere inability to perceive things 
accurately, to remember accurately, and there- 
fore to state things accurately. With the 
deterioration of the personality, that is, of the 
will, one would naturally expect that the deteri- 
oration of morals would go hand in hand. One 
cannot remain moral or virtuous without suf- 
ficient will to do so, and without sufficient will to 
make a struggle for self-control, and this is so 
in the case of a mind poisoned by alcohol. I do 
not claim that lack of morals is a disease, but 
moral development has appeared late in the de- 
velopment of the race, and such racial develop- 
ment is expressed by the individual. With the 
deteriorated mentality of the alcoholic, we must 
expect that the characteristics of late develop- 
ment will be the first to go, and for this reason 
we must realize that alcoholism naturally tends 
to immorality and crime. As a matter of fact, 



284 APPENDIX 

it is claimed that fifty per cent, of the crimes in 
France and forty-one per cent, in Germany are 
due to alcoholism, and no doubt in England and 
America the percentage is equally high. As 
might be expected, the offenses are principally 
those of disregard of the rights of others, con- 
tempt of law and order, assault, disturbances of 
domestic peace and robbery, and to all these 
crimes the habitual drunkard is particularly 
prone. 

But it is not my purpose to discuss the effect 
of alcohol in any way except as it pertains to the 
human body, nor to go into the reasons why 
men so poison their bodies as to bring about 
these deleterious results. The deterioration 
that we have been considering, when occurring 
in the mind, would naturally cause one to infer 
that insanity must also be common in those who 
are addicted to alcohol, and such is indeed the 
case. In New York State alone I believe it can 
be safely said that fully ten per cent, of the 
women and thirty per cent, of the men confined 
in the state asylums are there through forms of 
insanity caused by alcohol. It will not profit us 
to go into the various forms of alcoholic insan- 
ity, but when we realize that one -third of the 
men in the insane asylums to-day in New York 



APPENDIX 285 

are there because of excessive indulgence in al- 
cohol, and also that the State spends annually 
over six million dollars to care for them, we 
realize both the terrible ravages that alcoholic 
poison has made on the mentality of men and the 
enormous cost that it entails upon the commu- 
nity. 

As to the alcohol circulating in the blood, 
there is an endeavor naturally to get rid of it as 
with all poisons, and the kidneys in this en- 
deavor show the same processes that are else- 
where seen, of destruction of the specific cells, 
congestion, and increased connective tissue 
growth. Whether it is that these cells are de- 
stroyed in an endeavor to eliminate various sub- 
stances for which they are not fitted and break 
down under the strain, or whether they are di- 
rectly poisoned by the alcohol itself, the result- 
ant factors are those best understood in the lay 
mind as acute and chronic Bright 's disease. 
Whether or not alcohol produces these various 
processes in the kidneys which result in these 
diseased conditions, there is no question but that 
certain of these diseased conditions appear more 
frequently in alcoholics than in others. Besides 
the destructive processes about which we have 
been speaking in the various viscera, there are 



286 APPENDIX 

certain results of alcohol that may be said to 
affect the general condition of the individual. 
By this I mean the general resistance to bac- 
terial infection, the resistance to injury to the 
body, and the ability to repair such injuries. 
Alcohol diminishes the power of the body to 
resist bacterial infection. The alcoholic is more 
prone to acquire bacterial diseases, and when 
these are acquired he is infinitely less able to 
resist them. In Bellevue Hospital in 1904 there 
were 1,001 patients with lobar pneumonia. Of 
these, 667 gave a history of alcoholism ; 334 were 
non-alcoholics, which means that there were 
twice as many alcoholics suffering from this dis- 
ease as non-alcoholics. Among the alcoholics 
the mortality was fifty per cent., and among the 
non-alcoholics, 23.9 per cent. Here again the 
mortality among the alcoholics was more than 
double that which prevailed among those who 
had not taken this narcotic. The same is true 
of other infectious diseases. When injuries oc- 
cur to the body, such as broken legs or arms, 
there is a very wide difference in the picture 
produced in those who have drunk to excess, and 
those who have been sober. The shock pro- 
duced in these instances is greater in the weak- 
ened nervous system of the alcoholic, and among 



APPENDIX 287 

those who have habitually taken alcohol there is 
a very great tendency after broken bones to de- 
velop delirium tremens, and when this occurs in 
these patients, the outlook is always very grave. 
A broken leg or arm does not bring with it any 
such danger to those who have led sober lives. 
The process of recovery from disease and acci- 
dent, owing to the deteriorated nervous system 
and the poisoned circulatory system, is much 
slower in alcoholics than in others. 

WEAK WILLS INHEKITED 

Unfortunately, the injury which alcohol does, 
and the processes of deterioration which it sets 
on foot, do not end with the individual. Alco- 
hol poisons and injures the germ cells of both 
sexes, and the offspring of those addicted to its 
use may inherit a weakened and injured nervous 
system. The taste for alcohol, the craving, so 
called, is not inherited. This idea that, because 
a man has an alcoholic father or mother, he 
inherits the taste for alcohol, is a superstition 
that has been used by the weak as an excuse 
both for overindulgence in alcohol, and as a 
further excuse why no attempt should be made 
to check their indulgence. What is inherited is 
a weak, unstable intellect and personality, prone 



^i APPENDIX 

to excesses in all tilings, one that is weak-willed 
and weak in resistance to temptation, and one 
more easily affected by alcohol than the ordi- 
nary normal individual. There is also often 
inherited a lack of moral perception and moral 
sense, cansing the individual to do things which 
make one doubt his sanity; yet he can not be 
called insane, but really wanders in the border 
line between mad and bad, which is often worse 
than insanity itself. Alcoholic inheritance does 
not stop at instability of the nervous system or 
weakness of the personality, and one is rather 
staggered to realize the high percentage of im- 
becile, epileptic and weak-minded children that 
may be born to alcoholic parents. A detailed 
study of the imbecile school-children through- 
out all Switzerland showed that fifty per cent, of 
them were born in the days nine months after 
the periods of greatest alcoholic indulge!:;-, 
such as the New Year, the Carnival, and the 
grape harvest, and that the births of the o4hei 
half of the imbeciles were evenly scattered 
through the remaining thirty-eight weeks of the 
year. It has been shown that in France, Ger- 
many, Poland and Switzerland, from twenty- 
eight to seventy per cent, of the epileptics in 
some of the institutions were the descendants of 



APPENDIX 289 

alcoholics. Demme, in comparing the results 
of the health and death rates between ten alco- 
holic families and ten non-alcoholic families, 
found that in the alcoholic families out of fifty- 
seven children, twenty-five were still-born or 
died in the first month of life ; twenty-two were 
designated as sick, and ten as healthy — while 
in the non-alcoholic families, five were still-born 
or died early, six were sick, and fifty were 
healthy. Thus only 17.5 per cent, in the alco- 
holic families were healthy, while eighty -two 
per cent, in the non-alcoholic families were 
healthy, and only eighteen per cent, not healthy. 
The percentages, therefore, were almost ex- 
actly reversed. These statistics mean that not 
alone may the chronic alcoholic bequeath 
his poisoned nervous system to posterity, 
but from the statistics in Switzerland of the 
imbecile children, we must realize that even a 
temporary debauch may leave a curse upon the 
innocent child ; they also mean that alcohol pro- 
duces those processes in the individual which 
tend to the degeneration of the race, and 
tend after a few generations to extinction, and 
thus does Nature benefit the race by turning a 
curse into a blessing through the extinction of 
the degenerate. 



l N 



